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pneumococcal immunisation

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There are two types of pneumococcal vaccine (1,2):

  • pneumococcal polysaccharide vaccine (PPV) contains purified capsular polysaccharide from each of 23 capsular types of pneumococcus
    • most healthy adults develop a good antibody response to a single dose of PPV by the third week following immunisation
    • antibody response may be reduced in those with immunological impairment and those with an absent or dysfunctional spleen
    • children younger than two years of age show poor antibody responses to immunisation with PPV

  • pneumococcal conjugate vaccine (PCV13) contains polysaccharide from thirteen common capsular types. These are conjugated to protein (CRM197) using similar manufacturing technology to that used for Haemophilus influenzae type b (Hib) and meningococcal conjugate vaccines

  • the pneumococcal polysaccharide and pneumococcal conjugate vaccines do not contain thiomersal. The vaccines are inactivated, do not contain live organisms and cannot cause the diseases against which they protect

  • pneumococcal conjugate vaccine (PCV10) contains polysaccharide from ten common capsular types. These are conjugated to protein D (derived from non-typeable Haemophilus influenzae) or tetanus toxoid or diphtheria toxoid carrier proteins. PCV10 is not currently used in the UK immunisation programme (1)

Immunisation is recommended in (1):

  • objective of the immunisation programme is to protect all of those for whom pneumococcal infection is likely to be more common and/or serious, i.e
    • infants as part of the routine childhood immunisation programme
    • those aged 65 years or over
    • children and adults in the clinical risk groups shown in table below

Primary care staff should identify patients for whom vaccine is recommended and use all opportunities to ensure that they are appropriately immunised, for example:

  • when immunising against influenza
  • at other routine consultations, especially on discharge after hospital admission

Clinical risk groups who should receive the pneumococcal immunisation

Clinical risk group Examples (decision based on clinical judgement)
Asplenia or dysfunction of the spleen This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.
Chronic respiratory disease (chronic respiratory disease refers to chronic lower respiratory tract disease) This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children with respiratory conditions caused by aspiration, or a neurological disease (e.g. cerebral palsy) with a risk of aspiration. Asthma is not an indication, unless so severe as to require continuous or frequently repeated use of systemic steroids
Chronic heart disease includes those requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure
Chronic kidney disease Nephrotic syndrome, chronic kidney disease at stages 4 and 5 and those on kidney dialysis or with kidney transplantation
Chronic liver disease includes cirrhosis, biliary atresia and chronic hepatitis.
Diabetes Diabetes mellitus requiring insulin or oral hypoglycaemic drugs. This does not include diabetes that is diet controlled.
Immunosuppression Due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, asplenia or splenic dysfunction, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement deficiency) Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day.
Individuals with cochlear implants It is important that immunisation does not delay the cochlear implantation
Individuals with cerebrospinal fluid leaks includes leakage of cerebrospinal fluid such as following trauma or major skull surgery. Conditions related to CSF leaks include all CSF shunts.
Occupational risk

is an association between exposure to metal fume and pneumonia and infectious pneumonia, particularly lobar pneumonia and between welding and invasive pneumococcal disease.

PPV23 (single 0.5ml dose in those who have not received PPV previously) should be considered for those at risk of frequent or continuous occupational exposure to metal fume (e.g. welders) taking into account the exposure control measures in place

Vaccination may reduce the risk of invasive pneumococcal disease but should not replace the need for measures to prevent or reduce exposure.

 

 

PCV is part of the childhood immunisation schedule

  • primary immunisation

    • infants under one year of age
      • primary course of PCV vaccination consists of two doses with an interval of two months between each dose (i.e. at two and four months of age)

  • reinforcing immunisation
    • a reinforcing (booster) dose of PCV is recommended at on or after the first birthday who have received a complete primary course of two PCV vaccines.

Check uptodate details in the The Green Book before prescribing/administering a pneumococcal vaccination.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a pneumococcal vaccine.

Reference:

  1. GP magazine (August 16th 2004):1.
  2. Immunisation Against Infectious Disease - "The Green Book".Chapter 25 Pneumococcal (April 2019)
  3. Drug and Therapeutics Bulletin (1998), 36 (10), 73-6.
  4. Extending meningitis C vaccine to 20-24 year olds; pneumococcal vaccine for at-risk under 2 year olds (4/1/02). PL/CMO/2002, PL/CNO/2002/1, PL/CPHO/2002/1.
  5. Adult immunisation update (6/8/03).PL/CMO/2003/6, PL/CNO/2003/7, PL/CPHO/2003/4
  6. Letter from the Chief Medical Officer, 31st March 2005.PL/CMO/2005/1.

Last edited 04/2019 and last reviewed 05/2019

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