Which Pneumococcal Vaccine To Give First

Symptoms And Causative Agent

Streptococcus pneumoniae bacteria, also called pneumococcal bacteria, pneumococci , and pneumococcus , are one of the leading causes of illness in young children. At least 90 types of pneumococcal bacteria are known to exist. As the name implies, they can cause pneumonia however, these bacteria also can cause bloodstream infections , meningitis, sinusitis, and middle ear infection, among other illnesses. Collectively, the different illnesses caused by Streptococcus pneumoniae are referred to as pneumococcal disease.

Symptoms of pneumococcal disease vary based on the specific illness the bacteria have caused. Pneumococcal pneumonia symptoms include fever, chest pain, cough, and shortness of breath. When pneumococci infect normally sterile locations, so-called invasive pneumococcal disease may result. The two major types of invasive pneumococcal disease are bacteremia and meningitis . Pneumococcal meningitis symptoms include fever, headache, stiffness in the neck, light sensitivity, and disorientation. Pneumococcal bacteremia may complicate localized infections such as pneumonia and is commonly associated with high fever and shaking chills.

Invasive pneumococcal disease can be fatal survivors of meningitis may have permanent injury, including brain damage, seizures, or hearing loss.

What Does Shared Clinical Decision

• PCV13 is a safe and effective vaccine for older adults. The risk for PCV13-type disease among adults aged 65 years is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects . The remaining risk is a function of each individual patients risk of exposure to PCV13 serotypes and the influence of underlying medical conditions on the patients risk of developing pneumococcal disease if exposure occurs.
• The following adults aged 65 years are potentially at increased risk of exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination, and providers/practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged 65 years who have not previously received PCV13:
• Persons residing in nursing homes or other long-term care facilities
• Persons residing in settings with low pediatric PCV13 uptake
• Persons traveling to settings with no pediatric PCV13 program

Persons With Inadequate Immunization Records

Children and adults lacking adequate documentation of immunization should be considered unimmunized and should be started on an immunization schedule appropriate for their age and risk factors. Pneumococcal vaccines may be given, regardless of possible previous receipt of the vaccines, as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information about vaccination of people with inadequate immunization records.

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An Ounce Of Prevention Is Worth A Pound Of Cure

In the 1940s all of the strains of pneumococcus could be treated with the antibiotic, penicillin. However, over time many pneumococcal strains have become resistant not only to penicillin, but also to other antibiotics developed to combat bacterial infections. Resistance means that bacteria have changed, or evolved, so that they are no longer killed by one or more antibiotics. As a result, treatment with those antibiotics is not effective against those resistant strains.

Strains of pneumococcus have now been identified that are highly resistant to most antibiotics. Our reliance on and overuse of antibiotics have led to this resistance, backing us into a corner when treating infections caused by these and other types of bacteria. Unfortunately, we have taken our first steps into a post-antibiotic era. This makes the use of vaccines all the more important.

Booster Doses Of Pneumococcal Vaccine

If you’re at increased risk of a pneumococcal infection, you’ll be given a single dose of the PPV vaccine.

But if your spleen does not work properly or you have a chronic kidney condition, you may need booster doses of PPV every 5 years.

This is because your levels of antibodies against the infection decrease over time.

Your GP surgery will advise you on whether you’ll need a booster dose.

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Patients In Health Care Institutions

Residents of long-term care facilities should receive Pneu-P-23 vaccine. Refer to Recommendations for Use for information about pneumococcal vaccination of individuals at increased risk of IPD. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional information about vaccination of patients in health care institutions.

Pneumococcal Disease In Children

In children, the most common manifestation is bacteraemia without focus. This accounts for approximately 70% of IPD, followed by pneumonia with bacteraemia.

Meningitis is the least common but most severe category of IPD

• irritability
• seizures

Acute otitis media is the most common non-invasive manifestation of pneumococcal disease in children. Streptococcus pneumoniae is detected in 2855% of middle ear aspirates from children with acute otitis media.34,38,39

Pneumococcal disease in adults

In adults, pneumonia with bacteraemia is the most common manifestation of IPD

• more than one-third of all community-acquired pneumonia
• up to half of hospitalised pneumonia in adults

However, it is difficult to accurately determine the proportion attributable to pneumococci in cases of non-bacteraemic pneumonia.

Symptoms of pneumonia include:

• chest pain

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Analysis Of Healthcare Interventions That Change Patient Trajectoriesyour Browser Indicates If You’ve Visited This Link

The Leapfrog Group¹ has made installing CPOE in hospitals one of its recommendations (Birkmeyer et al … estimates of the short-term costs and benefits of influenza and pneumococcal vaccination, and of screening for cancers of the breast, cervix …

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Can I buy medicine and take it myself without a doctor’s prescription?

To protect the health of yourself and your family, when having health problems, you need to go to medical facilities to be examined and consulted by doctors as well as to prescribe appropriate drugs, absolutely do not self-use drugs under any situation to limit the risks and unfortunate consequences.

What is the difference between the terms Telehealth, Telemedicine and Virtual Care?

Telehealth is a broad term that includes telehealth services and other telehealth related activities based on digital platforms. While telemedicine generally refers to the practice of telemedicine and evidence-based and performed by medical personnel. Virtual care means any digital health service that involves remote interaction between the patient and the supplier such as appointment booking, chatting consultations and even examination by video call.

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Medical Conditions Resulting In High Risk Of Ipd

Table 1: Medical Conditions Resulting in High risk of IPD

Non-immunocompromising conditions

IPD is more common in the winter and spring in temperate climates.

Spectrum of clinical illness

Although asymptomatic upper respiratory tract colonization is common, infection with S. pneumoniae may result in severe disease. IPD is a severe form of infection that occurs when S. pneumoniae invades normally sterile sites, such as the bloodstream or central nervous system. Bacteremia and meningitis are the most common manifestations of IPD in children 2 years of age and younger. Bacteremic pneumococcal pneumonia is the most common presentation among adults and is a common complication following influenza. The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons. Bacterial spread within the respiratory tract may result in AOM, sinusitis or recurrent bronchitis.

Disease distribution

Worldwide, pneumococcal disease is a major cause of morbidity and mortality. The World Health Organization estimates that almost 500,000 deaths among children aged less than 5 years are attributable to pneumococcal disease each year. In Canada, IPD is most common among the very young and adults over 65 years of age.

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Select Safety Information For Pneumovax 23

Do not administer PNEUMOVAX®23 to individuals with a history of a hypersensitivity reaction to any component of the vaccine.

Defer vaccination with PNEUMOVAX 23 in persons with moderate or severe acute illness.

Use caution and appropriate care in administering PNEUMOVAX 23 to individuals with severely compromised cardiovascular and/or pulmonary function in whom a systemic reaction would pose a significant risk.

Available human data from clinical trials of PNEUMOVAX 23 in pregnancy have not established the presence or absence of a vaccine-associated risk.

Since elderly individuals may not tolerate medical interventions as well as younger individuals, a higher frequency and/or a greater severity of reactions in some older individuals cannot be ruled out.

Persons who are immunocompromised, including persons receiving immunosuppressive therapy, may have a diminished immune response to PNEUMOVAX 23.

PNEUMOVAX 23 may not be effective in preventing pneumococcal meningitis in patients who have chronic cerebrospinal fluid leakage resulting from congenital lesions, skull fractures, or neurosurgical procedures.

For subjects aged 65 years or older in a clinical study, systemic adverse reactions which were determined by the investigator to be vaccine-related were higher following revaccination than following initial vaccination.

Vaccination with PNEUMOVAX 23 may not offer 100% protection from pneumococcal infection.

Recommendations For Adults With Previous Ppsv23 Vaccinations

Adults 65 years of age or older who do not have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak and who have not previously received PCV13 may receive a dose of PCV13. Based on , clinicians and these older adults can discuss PCV13 vaccination to decide if it is appropriate. For those who choose to receive PCV13, give the dose of PCV13 at least 1 year after the most recent PPSV23 dose. Additionally, all adults 65 years or older should receive 1 dose of PPSV23 after age 65 years old regardless of their previous PPSV23 vaccination history. Doses of PPSV23 should be spaced 5 years apart from each other.

Adults 19 years of age or older who previously received one or more doses of PPSV23 should receive a dose of PCV13 at least one year after administration of the most recent PPSV23 dose if they have

• Immunocompromising conditions
• CSF leaks
• Cochlear implants

For those who require an additional dose of PPSV23, administer it no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.

Pneumococcal Vaccine Timing for Adults pdf icon provides a summary of this detailed guidance.

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Common And Local Adverse Events

Pneumococcal conjugate vaccine

Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38°C occurring in approximately 3% of vaccine recipients.

Pneumococcal polysaccharide vaccine

Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.

Administration With Other Vaccines

Never administer PCV13 and PPSV23 during the same visit. If a patient needs both vaccines, you should administer PCV13 first, followed by PPSV23 at another visit. The interval between administrations depends on the age of the patient, the indication for giving it, and which vaccine you administer first. See the table below for additional information.

* Medical conditions include cochlear implants, cerebrospinal fluid leaks, functional or anatomic asplenia, and immunocompromising conditions like HIV infection, cancer, or chronic renal failure.

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Which Adults Should Get The Pneumococcal Vaccine

The following groups of adults should get both types of the pneumococcal vaccine :

• Adults 65 years and older because they are at high risk of pneumococcal infections
• Adults without a functioning spleen
• Adults who are immune compromised by disease, chemotherapy or steroids
• Individuals who are HIV positive

The following groups of adults should get the polysaccharide pneumococcal vaccine regardless of age:

• Adults who smoke or suffer from alcoholism
• Adults with heart or lung disease, liver disease, asthma, diabetes or cancer

Indication For Pneumovax 23

PNEUMOVAX®23 is a vaccine indicated for active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine .

PNEUMOVAX 23 is approved for use in persons 50 years of age or older and persons aged 2 years who are at increased risk for pneumococcal disease.

PNEUMOVAX 23 will not prevent disease caused by capsular types of pneumococcus other than those contained in the vaccine.

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Improving How Vaccines Are Offered In Scotland

To improve how vaccinations are offered to you or your child, you may notice:

• you’re invited to a new location to receive your immunisations instead of your GP practice
• the health professional giving your immunisations changes

You’ll still receive clear information about the location, date and time of your appointment.

Route Site And Needle Size

Administer pneumococcal polysaccharide vaccine intramuscularly or subcutaneously. Administer pneumococcal conjugate vaccine intramuscularly. The preferred site for infants and young children is the vastus lateralis muscle in the anterolateral thigh. The preferred injection site in older children and adults is the deltoid muscle. Use a needle length appropriate for the age and size of the person receiving the vaccine.

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How Is The Pneumococcal Vaccine Made

Like the Hib vaccine, the pneumococcal vaccine is made from the sugar coating of the bacteria. Antibodies directed against the pneumococcal polysaccharide protect the child without having to take the risk that their first encounter with natural pneumococcus will result in permanent disabilities or death.

Unfortunately, children less than 2 years old don’t develop very good immune responses to this polysaccharide alone. So the pneumococcal vaccine was made in a manner similar to the Hib vaccine . The pneumococcal polysaccharide is linked to a harmless protein. This version of the vaccine is referred to as the pneumococcal conjugate vaccine. Once linked, young children are able to make an immune response to the polysaccharide. The big difference between the pneumococcal vaccine and the Hib vaccine is the number of different types of polysaccharides that need to be included in the vaccine. Whereas, there is really only one strain of Hib that causes disease in children, there are about 90 different strains of pneumococcus. Fortunately, most of the serious disease in young children is caused by the 13 strains of pneumococcus contained in the vaccine.

The pneumococcal vaccine was found to be highly effective in preventing severe pneumococcal infection in a large trial of children injected with the vaccine. About 40,000 children were included in the initial trial of the vaccine. Since its licensure, the pneumococcal vaccine has been given to millions of children safely.

Questions To Ask Your Doctor

• When should I make an appointment to get each type of pneumococcal vaccine?
• Should I still get the vaccines if Ive recently had pneumonia?
• Should I wait to turn 65 before I get each dose of pneumococcal vaccines?
• If I have a negative reaction to one type of pneumococcal vaccine, am I likely to have that same reaction to the other?

Funding was provided for these pneumococcal resources through an unrestricted grant from Pfizer Independent Grant for Learning and Change .

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What Are The Possible Side Effects Of Pcv And Ppsv Vaccines

Kids may have redness, tenderness, or swelling where the shot was given. A child also might have a fever after getting the shot. There is a very small chance of an allergic reaction with any vaccine.

The pneumococcal vaccines contain only a small piece of the germ and so cannot cause pneumococcal disease.

How Many Doses Of Ppsv23 Can An Adult Get In A Lifetime Who/when

CDC recommends some adults receive up to 3 doses of PPSV23 in a lifetime. Adults who have immunocompromising conditions should receive two doses of PPSV23, given 5 years apart, before age 65 years. Those adults should then receive a third dose of PPSV23 at or after 65 years, as long as its been at least 5 years since the most recent dose.

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Who Should Have The Pneumococcal Vaccine

Anyone can get a pneumococcal infection. But some people are at higher risk of serious illness, so it’s recommended they’re given the pneumococcal vaccination on the NHS.

These include:

• babies
• adults aged 65 or over
• children and adults with certain long-term health conditions, such as a serious heart or kidney condition

Babies are offered 2 doses of pneumococcal vaccine, at 12 weeks and at 1 year of age.

People aged 65 and over only need a single pneumococcal vaccination. This vaccine is not given annually like the flu jab.

If you have a long-term health condition you may only need a single, one-off pneumococcal vaccination, or a vaccination every 5 years, depending on your underlying health problem.

A Look At Each Vaccine: Pneumococcal Vaccine

Much like Haemophilus influenzae type b , pneumococcal bacteria affect the most defenseless of the population . The diseases caused by pneumococcus include meningitis , bloodstream infections and pneumonia . The pneumococcal vaccine was first introduced for use in all infants in the United States in 2000. Before the vaccine, every year pneumococcus caused about 700 cases of meningitis, 17,000 cases of bloodstream infections, 200 deaths and 5 million ear infections in children.

Infants and young children are at greatest risk of serious infection because they are unable to develop immunity to the sugar that coats the bacteria, something that older children can do when they are more than 2 years of age.

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