Review And Update On Pneumococcal Vaccine Recommendations
Jaime R. Hornecker, PharmD, BCPS, CDCES, DPLAUniversity of Wyoming School of PharmacyCasper, Wyoming
University of Wyoming School of PharmacyCasper, Wyoming
US Pharm. 2021 46:32-35.
ABSTRACT: Infections caused by Streptococcus pneumoniae represent a significant public-health concern. Invasive pneumococcal disease, including pneumonia, meningitis, and bacteremia, are more common in high-risk populations, including young children, older adults, and the immunocompromised. PPSV23 and PCV13 are two vaccines included as part of routine immunization schedules and are recommended for use in those with high-risk comorbidities. Pharmacists play an important role in improving immunization rates and reducing missed opportunities for pneumococcal vaccinations.
Infections caused by Streptococcus pneumoniae are a global health concern. In the United States, CDC estimates indicate that 150,000 hospitalizations due to pneumococcal pneumonia occur each year.1 Worldwide, S pneumoniae is the leading cause of pneumonia-related death.2
S pneumoniae is a Gram-positive bacterium that commonly colonizes the respiratory tract. Pneumococcal infections range from otitis media and sinusitis to more severe infections, known as invasive pneumococcal disease .1 IPD includes pneumonia, meningitis, and bacteremia, with case-fatality rates approaching 18%.3
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.
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.
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Available Vaccines And Vaccination Campaigns
A pneumococcal vaccine that protected against 14 different strains was licensed in 1977, and expanded to protect against 23 strains in 1983. This vaccine is a polysaccharide vaccine called PPSV23 . However, it is most effective in adults, and does not consistently generate immunity in children younger than two years old. A separate vaccine for children called PCV7 was licensed in 2000. PCV7 is a conjugate vaccine it was expanded to include protection against 13 strains in 2010, and renamed PCV13 . PCV13 protects against the bacterial strains responsible for the most severe childhood pneumococcal infections.
PCV7 was added to the recommended childhood vaccination schedule in 2000 . Since the initial recommendation, invasive pneumococcal disease in children has dropped by nearly 80% in the United States.
Pneumococcal Infections After Influenza
Pneumococcus is known as an opportunistic infection because it lives in the respiratory tract of people without causing disease, but when the respiratory tract is compromised by an infection such as influenza, the bacteria then invades the lungs , bloodstream , or brain and spinal cord . Activities like smoking can also disrupt the lining of the nose and throat and allow for pneumococcal infections and subsequent disease.
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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 .
How The Pneumococcal Vaccine Works
Both types of pneumococcal vaccine encourage your body to produce antibodies against pneumococcal bacteria.
Antibodies are proteins produced by the body to neutralise or destroy disease-carrying organisms and toxins.
They protect you from becoming ill if you’re infected with the bacteria.
More than 90 different strains of the pneumococcal bacterium have been identified, although most of these strains do not cause serious infections.
The childhood vaccine protects against 13 strains of the pneumococcal bacterium, while the adult vaccine protects against 23 strains.
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Is It True That More Than One Type Of Infection Can Cause Meningitis
Yes. Everyone has heard it on the news the story of a local student infected with meningitis. Such a report inevitably results in many questions and a great amount of concern and even fear among families with children in the affected school.
There are some important considerations when this happens. First, it is important to remember that meningitis refers to an infection that has reached the lining of the brain and spinal cord. Second, it can be caused by viruses or bacteria .
Viral meningitis, the most common type of meningitis, is often less severe than bacterial meningitis. Vaccine-preventable diseases that can cause viral meningitis include measles, mumps, chickenpox and influenza.
Most, but not all, cases of bacterial meningitis can be prevented by vaccination. The bacteria most often associated with meningitis include meningococcus, pneumococcus, and Haemophilus influenzae type B . Fortunately, by the age of 2, most children are fully immunized against pneumococcus and Hib and most adolescents are protected against meningococcus.
How Do The Pneumonia Vaccines Work
Like all vaccines, pneumococcal vaccines work by showing the immune system a version of the microbe, or a part of it, that is responsible for the infection. The pneumococcal vaccine contains part of the pneumococcus bacterias outer shell, made of molecules called polysaccharides. The immune system learns to recognize it, attack it, and defend the body against it, should it ever come into contact with the real bacteria.
The body does this by making antibodies against the shell of the pneumococcus bacteria. These antibodies stay in your bloodstream as part of your immune system. If you are exposed to pneumococci in the future, the antibodies recognize the bacterias shell and launch a targeted defense.
There are strains of pneumococcus, so the vaccines are made up of molecules from many of those strains.
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Intervals Between Pcv13 And Ppsv23 Vaccines: Recommendations Of The Advisory Committee On Immunization Practices
Please note: Anerratum has been published for this article. To view the erratum, please click here.
Miwako Kobayashi, MD1,2 Nancy M Bennett, MD3,4 Ryan Gierke, MPH1 Olivia Almendares, MSPH1 Matthew R Moore, MD1 Cynthia G. Whitney, MD1 Tamara Pilishvili, MPH1
Two pneumococcal vaccines are currently licensed for use in the United States: the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine . The Advisory Committee on Immunization Practices currently recommends that a dose of PCV13 be followed by a dose of PPSV23 in all adults aged 65 years who have not previously received pneumococcal vaccine and in persons aged 2 years who are at high risk for pneumococcal disease because of underlying medical conditions . The recommended intervals between PCV13 and PPSV23 given in series differ by age and risk group and the order in which the two vaccines are given .
On June 25, 2015, ACIP changed the recommended interval between PCV13 followed by PPSV23 from 612 months to 1 year for immunocompetent adults aged 65 years. Recommended intervals for all other age and risk groups remain unchanged. This report outlines the rationale for this change and summarizes the evidence considered by ACIP to make this recommendation.
What Are The Side Effects Of The Pneumococcal Vaccine
After receiving the pneumococcal vaccine, children commonly will have pain or swelling where the shot is given and occasionally low-grade fever. About 1 of every 100 children will develop a high fever.
Side effects from the polysaccharide version used in adults include tenderness and redness at the injection site, and about 1 of every 100 people will get a fever and experience muscle aches.
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How Much Will It Cost
At this time, Prevnar 20s list price hasnt been announced. However, this vaccine will likely be common for older adults, and its expected that Medicare will cover the bill. Pneumococcal vaccines are a cost-free benefit of Medicare Part B, and people with original Medicare or Medicare Advantage can receive covered pneumococcal vaccines with specific providers.
If you have Medicaid, check with your state Medicaid agency to see which vaccines are offered. Many Medicaid plans pay for some vaccines, but specific coverage varies.
All Health Insurance Marketplace plans and many private plans cover pneumococcal vaccines when provided by an in-network provider, but costs can vary depending on the specific insurance plan.
For people without insurance or adequate coverage, financial assistance and coupon programs may be available. Check back with GoodRx to find more ways to save and make your vaccinations more affordable.
Effectiveness Of The Pneumococcal Vaccine
Children respond very well to the pneumococcal vaccine.
The introduction of this vaccine into the NHS childhood vaccination schedule has resulted in a large reduction in pneumococcal disease.
The pneumococcal vaccine given to older children and adults is thought to be around 50 to 70% effective at preventing pneumococcal disease.
Both types of pneumococcal vaccine are inactivated or “killed” vaccines and do not contain any live organisms. They cannot cause the infections they protect against.
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Who Shouldnt Get Prevnar 20
People who have had a severe allergic reaction in the past to any of the vaccines ingredients including diphtheria protein should not receive Prevnar 20. People who are 17 years or younger also shouldnt receive this vaccine.
At this time, the FDA didnt place any other restrictions on who can receive Prevnar 20. If youre unsure if you should receive this vaccine, your healthcare provider can give you more information.
Who Should Not Get The Vaccine
People should not get the vaccine if they have had a life threatening allergic reaction to a previous dose.
Additionally, a person should not undergo vaccination if they have had an allergic reaction to medication containing diphtheria toxoid or an earlier form of the pneumonia vaccination .
Lastly, people who are sick or have allergic reactions to any of the ingredients of the vaccine should talk to a doctor before getting the shot.
A pneumonia shot will not reduce pneumonia. However, it helps prevent invasive pneumococcal diseases, such as meningitis, endocarditis, empyema, and bacteremia, which is when bacteria enter the bloodstream.
Noninvasive pneumococcal disease includes sinusitis.
There are two types of pneumonia shots available. Which type a person gets depends on their age, whether or not they smoke, and the presence of any underlying medical conditions.
The two types are:
- Pneumococcal conjugate vaccine : Healthcare providers recommend this vaccine for young children, people with certain underlying conditions, and some people over the age of 65 years.
- Pneumococcal polysaccharide vaccine : Healthcare providers recommend this vaccine for anyone over 65 years of age, people with certain underlying conditions, and people who smoke.
According to the
- roughly 8 in 10 babies from invasive pneumococcal disease
- 45 in 100 adults 65 years or older against pneumococcal pneumonia
- 75 in 100 adults 65 years or older against invasive pneumococcal disease
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Are The Pneumonia Vaccines Safe
Yes, pneumonia vaccines are safe. Like all vaccines, they go through rigorous scientific testing and review. Although both pneumococcal vaccines can cause mild side effects, severe reactions to the vaccines are rare. In one study of adults over age 70 who received the PCV13 and PPSV23 vaccines, there was only one adverse event that was related to the vaccine.
Allergic reactions to vaccines are rare, but they can occur and may be serious. If you have had an allergic reaction to one of the ingredients in the pneumococcal vaccines or to a prior dose of a pneumococcal vaccine, you should not get vaccinated without talking to your healthcare provider first.
If you have questions about whether the pneumonia vaccines are safe for you, discuss this with your healthcare provider. You can also find information about pneumococcal vaccine safety here.
What Side Effects Should I Look Out For
Side effects vary from vaccine to vaccine, according to Privor-Dumm.
According to the U.S Department of Health and Human Services website Vaccine.org, common issues include:
- Soreness at the injection site
- A low-grade fever
- Muscle aches
- Fatigue
In very rare cases, you may be allergic to the ingredients in a vaccine or have another severe reaction. If you feel sick in any way after receiving a shot, call your doctor, Privor-Dumm says.
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Epidemiology And Risk Factors
Although invasive pneumococcal disease is much less prevalent than noninvasive disease, it confers significant mortality risk , and survivors can be left with significant sequelae . Furthermore, given the widespread use of empiric antibiotics and frequent lack of timely culture or urinary antigen data, the true burden of primary and invasive pneumococcal disease may be significantly underestimated .
Certain groups are at particularly high risk for invasive pneumococcal disease: young children, the elderly, and those with high-risk comorbid diseases or substance habits. The Centers for Disease Control and Preventions Active Bacterial Core Surveillance data from 2013 demonstrated increased rates of invasive pneumococcal disease in children younger than age 5 years and in adults 65 years or older .
Independent of age, the presence of other comorbid chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disease , asthma, renal insufficiency, and diabetes mellitus increases the risk for invasive pneumococcal disease . Patients with common pulmonary conditions like COPD and asthma have a two- to sixfold risk for invasive pneumococcal disease compared with the general population . In addition, active smoking confers increased risk, as do alcohol and intravenous drug use .
How Often Do You Need To Get The Pneumonia Vaccines
Sometimes, vaccines require a booster shot. This means that an additional shot is given after the initial one to make sure that you dont lose immunity over time.
PCV13 never requires a booster shot in children or adults after all recommended doses are received.
Sometimes, PPSV23 requires a booster shot, depending on when and why it was given:
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Children who get PPSV23 due to certain health conditions, like cancer and conditions that weaken the immune system, need a booster 5 years after the first dose.
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Adults who get PPSV23 before age 65 should get one booster at least 5 years after the first dose, once theyve turned 65. No booster is needed if the first dose is given after age 65.
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Adults with a weakened immune system and other specific conditions should have another dose 5 years after their first dose, and then one more dose at least 5 years after their most recent dose, once theyve turned 65.
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How Effective Is Each Vaccine
Vaccines help protect against disease, but no vaccine is 100% effective.
Studies show that at least one dose of Prevnar 13 protects 80% of babies from serious pneumococcal infections, 75% of adults age 65 and older from invasive pneumococcal disease , and 45% of adults age 65 and older from pneumococcal pneumonia.
Studies show that one dose of Pneumovax 23 protects 50% to 85% of healthy adults against invasive pneumococcal disease.
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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Problems That Could Happen After Getting Any Injected Vaccine
- People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your doctor if you or your child:
- Feel dizzy
- Have vision changes
- Have ringing in the ears
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.
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