Pneumococal Patient Information
Pneumococcal vaccines protect against infection with Streptococcus pneumoniae (pneumococcus); the vaccines contain polysaccharide from capsular pneumococci. Pneumococcal polysaccharide vaccine contains purified polysaccharide from 23 capsular types of pneumococci, whereas pneumococcal polysaccharide conjugate vaccine (adsorbed) contains polysaccharide from either 10 capsular types (Synflorix®) or 13 capsular types (Prevenar 13®) and the polysaccharide is conjugated to protein.
The 13-valent conjugate vaccine (Prevenar 13®) is used in the childhood immunisation schedule. The recommended schedule consists of 3 doses, the first at 2 months of age, the second at 4 months, and the third at 12–13 months
Pneumococcal vaccination is recommended for individuals at increased risk of pneumococcal infection as follows:
- age over 65 years;
- asplenia or splenic dysfunction (including homozygous sickle cell disease and coeliac disease which could lead to splenic dysfunction);
- chronic respiratory disease (includes asthma treated with continuous or frequent use of a systemic corticosteroid);
- chronic heart disease;
- chronic renal disease;
- chronic renal disease;
- chronic neurological conditions;
- complement disorders;
- diabetes mellitus requiring insulin or oral hypoglycaemic drugs;
- immune deficiency because of disease (e.g. HIV infection) or treatment (including prolonged systemic corticosteroid treatment for over 1 month at dose equivalents of prednisolone: adult and child over 20 kg, 20 mg or more daily; child under 20 kg, 1 mg/kg or more daily);
- presence of cochlear implant;
- conditions where leakage of cerebrospinal fluid may occur;
- child under 5 years with a history of invasive pneumococcal disease;
- at risk of occupational exposure to metal fume (e.g. welders).
Where possible, the vaccine should be given at least 2 weeks before splenectomy, cochlear implant surgery, chemotherapy, or radiotherapy; patients should be given advice about increased risk of pneumococcal infection. If it is not practical to vaccinate at least 2 weeks before splenectomy, chemotherapy, or radiotherapy, the vaccine should be given at least 2 weeks after the splenectomy or, where possible, at least 3 months after completion of chemotherapy or radiotherapy. Prophylactic antibacterial therapy against pneumococcal infection (Table 2, section 5.1) should not be stopped after immunisation. A patient card and information leaflet for patients with asplenia are available from the Department of Health or in Scotland from the Scottish Government, Health Protection Division (Tel (0131) 244 2879).
Choice of vaccine
Children under 2 years at increased risk of pneumococcal infection (see list above) should receive the 13-valent pneumococcal polysaccharide conjugate vaccine (adsorbed) at the recommended ages, followed by a single dose of the 23-valent pneumococcal polysaccharide vaccine after their second birthday (see below). Children at increased risk of pneumococcal infection presenting late for vaccination should receive 2 doses (separated by at least 1 month) of the 13-valent pneumococcal polysaccharide conjugate vaccine (adsorbed) before the age of 12 months, and a third dose at 12–13 months. Children over 12 months and under 5 years (who have not been vaccinated or not completed the primary course) should receive a single dose of the 13-valent pneumococcal polysaccharide conjugate vaccine (adsorbed) (2 doses separated by an interval of 2 months in the immunocompromised or those with asplenia or splenic dysfunction). All children under 5 years at increased risk of pneumococcal infection should receive a single dose of the 23-valent pneumococcal polysaccharide vaccine after their second birthday and at least 2 months after the final dose of the 13-valent pneumococcal polysaccharide conjugate vaccine (adsorbed).
Children over 5 years and adults who are at increased risk of pneumococcal disease should receive a single dose of the 23-valent unconjugated pneumococcal polysaccharide vaccine.
In individuals with higher concentrations of antibodies to pneumococcal polysaccharides, revaccination with the 23-valent pneumococcal polysaccharide vaccine more commonly produces adverse reactions. Revaccination is therefore not recommended, except every 5 years in individuals in whom the antibody concentration is likely to decline rapidly (e.g. asplenia, splenic dysfunction and nephrotic syndrome). If there is doubt, the need for revaccination should be discussed with a haematologist, immunologist, or microbiologist.