How are pneumococcal infections prevented?

Updated: Aug 27, 2018
  • Author: Claudia Antonieta Nieves Prado, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Until February 2010, two pneumococcal vaccines were available for use in the prevention of pneumococcal disease. On February 24, 2010, the FDA approved the use of PCV13 vaccine for use in children aged 2-71 months, and its use replaces PCV7. [17, 73, 74, 75, 76, 77, 78, 79]

The capsular polysaccharide vaccine (PPSV23), licensed in 1977, contains capsular antigens from the 23 serotypes of S pneumoniae that cause most of the infections in the United States. After vaccination with the polysaccharide vaccine, persons aged 5 years and older develop type-specific protective antibodies. Polysaccharide vaccines produce antibodies primarily through T-cell–independent methods. Because these systems are not fully developed in young children, children younger than 2 years have a poor response to these types of vaccines. [70] In some elderly persons and persons of all ages with immunosuppressive conditions, the immunogenicity is similarly poor. No anamnestic response occurs with revaccination, and the duration of immunity with the polysaccharide vaccine is unknown. Neither a decrease in pneumococcal carriage rates or protection of unimmunized persons due to herd immunity has been documented after immunization using the polysaccharide vaccine.

A 13-valent pneumococcal conjugate vaccine (PVC13) was licensed for use in 2010 and includes antigens from the capsules of 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F). When this vaccine was introduced in 2010, it replaced PCV7. The additional 6 serotypes accounted for the majority of pneumococcal isolates that caused invasive disease since the introduction of PCV7 in 2000. [16]

Pneumococcal conjugate vaccines link capsular polysaccharides to a conjugate (diphtheroid) carrier protein. Responses to these antigens are developed using T-cell–dependent mechanisms. These antibodies induce immunologic memory, reduce carriage rates of pneumococcal vaccine-serotype isolates, and provide indirect protection to unimmunized persons via herd immunity.

Table 1. Routine Vaccination With Pneumococcal Vaccines [80, 81, 78] (Open Table in a new window)

Population

Vaccine

Children aged 6 weeks through 5 years: 0.5 mL IM; series of 4 doses at ages 2, 4, 6, and 12-15 months (catch-up schedule through age 5 y)

Pneumococcal conjugate vaccine 13-valent (Prevnar 13)

Adults ≥50 years*: 0.5 mL IM as a single dose

Pneumococcal conjugate vaccine 13-valent (Prevnar 13, PCV13)

Adults >65 years*†: 0.5 mL IM

Pneumococcal polyvalent vaccine 23-valent (PPSV23); 6-12 mo after PCV13

*Although PCV13 is licensed by the FDA for individuals aged ≥50 y, ACIP recommends routine vaccination with both PCV13 plus PPSV23 for individuals aged ≥65 y.

†Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose.

The Advisory Committee on Immunization Practices (ACIP) recommends that the pneumococcal vaccine (PPSV23) be given to high-risk children (children aged 2-6 y should complete the recommended doses of PCV13 before PPSV23 is given).

Table 2. Vaccination of High-Risk Children Aged 2-18 Years With Pneumococcal Polyvalent Vaccine 23-Valent [82] (Open Table in a new window)

Pediatric Risk Group

Condition

Immunocompetent

Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure)

Chronic lung disease (including asthma if treated with high-dose corticosteroids)

Diabetes mellitus

Cerebrospinal fluid leaks

Cochlear implant

Functional or anatomic asplenia

Sickle cell disease and other hemoglobinopathies

Congenital or acquired asplenia or splenic dysfunction

Immunocompromising conditions

HIV infection

Chronic renal failure and nephrotic syndrome

Immunosuppressive drugs or radiation therapy, malignant neoplasms, leukemias, lymphomas, Hodgkin disease, solid organ transplantation

Congenital immunodeficiency

Additionally, in August 2014, the ACIP published updated recommendations for pneumococcal vaccination of high-risk adults. The committee now recommends routine use of PCV13 in sequence with the previously recommended PPSV23. High-risk adults who have not previously received either pneumococcal vaccine should be given 1 dose of PCV13 followed a minimum of 8 weeks later by 1 dose of PPSV23. In patients who have previously received PPSV23, 1 dose of PCV13 should be administered a minimum of 1 year following the last PPSV23 dose. If the last PPSV23 dose was given prior to age 65 years and at least 1 year prior, PCV13 should be administered followed 6-12 months later by another PPSV23 dose. [83]

Table 3. Vaccination of High-Risk Adults Aged 19 Years or Older With Pneumococcal Vaccines [83] (Open Table in a new window)

Risk Group

Condition

PCV13

PPSV23

Revaccinate With PPSV23 5 Years After First Dose

Immunocompetent individuals

Chronic heart disease*

 

 

 

Chronic lung disease†

 

 

 

Diabetes mellitus

 

 

 

Cerebrospinal fluid leaks

x

x

 

Cochlear implant

x

x

 

Alcoholism

 

x

 

Chronic liver disease, cirrhosis

 

x

 

Functional or anatomic asplenia

Sickle cell disease and other hemoglobinopathies

x

x

x

Congenital or acquired asplenia

x

x

x

Immunocompromised individuals

Congenital or acquired immunodeficiency

x

x

x

HIV infection

x

x

x

Chronic renal failure

x

x

x

Nephrotic syndrome

x

x

x

Leukemia

x

x

x

Lymphoma

x

x

x

Hodgkin disease

x

x

x

Generalized malignancy

x

x

x

Iatrogenic immunosuppression‡

x

x

x

Solid organ transplant

x

x

x

Multiple myeloma

x

x

x

*Congestive heart failure and cardiomyopathies, excluding hypertension.

†Including chronic obstructive pulmonary disease, emphysema, and asthma.

‡Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.


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