Last Updated : 2/29/2016
Jagdish Kathwate*, Monica Madvariya**
What is pneumococcal disease?
Pneumococcal disease is an infection caused by the bacteria Streptococcus pneumoniae or pneumococcus. Pneumococci are certain bacteria which cause human illnesses including lung infections (pneumococcal pneumonia), brain infections (pneumococcal meningitis), blood infections (bacteremia) and middle ear infections (otitis media). People can be infected with the bacteria, or they can carry it in their throat, and not be ill. Those carriers can still spread it, primarily in droplets from their nose or mouth when they breathe, cough, or sneeze. Depending on what organ or part of the body is infected, pneumococcal disease will cause any of several serious illnesses, including:
• Bacterial meningitis, an infection of the covering of the brain and spinal cord that can present as fever, headache and vomiting and lead to confusion, coma, and death as well as other physical effects, such as blindness or paralysis
• Pneumonia, an infection of the lungs. A pneumococcal lung infection can cause high grade fever, cough, breathing difficulty and chest pain.
• Ear Infections: a common bacterial complication of influenza otitis media, a middle ear infection can cause pain, swelling, sleeplessness, fever, and irritability.
• Bacteremia, a dangerous infection of the blood stream. Patients can present with chills, joint pains, lethargy and poor alertness.
• Sinus infections
Lung, brain and ear infections can potentially cause death if untreated. In those who recover, there may be residual damage after brain infections, like hearing defects. Hence, vaccines against pneumococcus prevent not only the disease, but its sequelae as well.

Who gets Pneumococcal disease?
• Infants or young children
• Children with poor immunity, like splenectomised patients, HIV infected children
• Children with chronic heart or lung conditions
• Children with cochlear implants

What is Pneumococcal Vaccine?
For more than 30 years, there has been a vaccine that can safely prevent pneumococcal disease. Currently there are two types of pneumococcal vaccines available in market: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). Both differ in their components, mechanism of action and age at which they can be administered.
Considering that there are more than 90 types of pneumococcal bacteria, PCV13 gives protection against 13 disease causing types and PPSV23 against 23 types. Both are effective in preventing illnesses like brain infection and blood infection. PCV13 also protects against lung infection. PPSV vaccine (pneumococcal polysaccharide) cannot be used for the part of the population that is most vulnerable to the disease -- children under age 2 years of age.

What do these vaccines contain and how do they act?
Like many other vaccines, the pneumococcal vaccines contain killed bacteria.
Polysaccharide vaccines are not effective in children younger than 2 years, induce only short term immunity, and repeat doses do not give a “boost” to immunity. On the other hand, the conjugate vaccine is effective in children less than 2 years of age and repeat doses lead to an increase in immunity against pneumococci.

How are these vaccines administered?
The polysaccharide vaccine (PPSV23) is administered in either muscle or the fatty tissue of the arm or leg. The conjugate vaccine (PCV13) is administered in the muscle.

What is schedule for Pneumococcal vaccines?
Pneumococcal conjugate vaccine (PCV13)
FOR INFANTS AND YOUNG CHILDREN: PCV13 is licensed for the prevention of pneumococcal diseases in children below 5 years and in adults >50 years of age.
PCV13 is given as a series of four doses at the ages of:
• 6 weeks
• 10 weeks
• 14 weeks
• 15 months
Children who are not given the doses at the appropriate ages should still get the vaccine, but the number of doses and the dosing interval varies according to the age of the child. One dose of PCV13 should be given to all healthy children from 2 to 6 years of age who are not completely vaccinated for their age.

For children with underlying medical conditions (anatomic or functional asplenia (including sickle cell disease), HIV infection or an immunocompromising condition, cochlear implant or cerebrospinal fluid leak):
• 2-6 years : 1 dose of PCV13 if 3 doses of PCV were received previously, or 2 doses of PCV13 at least 8 weeks apart if fewer than 3 doses of PCV were received previously.
• 6 through 18 years : A single dose of PCV13.

Pneumococcal polysaccharide vaccine (PPSV23): The minimum age for PPSV 23 is 2 years. It is not recommended for routine use in healthy individuals. Its use is recommended only for the vaccination of persons with certain high-risk conditions.

Dosing schedule of PPSV
• 8 weeks after the last dose of PCV13 to children aged 2 years or older with the following conditions:
-anatomic or functional asplenia (including sickle cell disease)
-HIV infection
-cochlear implant
-cerebrospinal fluid leak.
• An additional dose after 5 years
PPSV should not be used alone for prevention of pneumococcal diseases; it should always be used in conjunction with PCV.

Can these vaccines be given to pregnant women?
Yes. Pregnancy is not a contraindication to pneumococcal immunization.

Are the pneumococcal vaccines safe in children?
Yes. Both PPSV23 and PCV13 are very safe. Mild reactions like local pain and soreness at site of injection may occur, especially with PPSV23. A few people may also have fever, muscle aches, or more severe local reactions. Rarely, severe allergic reactions may occur.

What is the effectiveness of pneumococcal polysaccharide vaccine (PPSV23)?
The effectiveness of PPSV23 ranges from 50%–80%. It also depends on the age of the recipient. Children less than 2 years, adults older than age 65 years and people with significant underlying illnesses have less rates of responsiveness. Still, vaccination with PPSV23 is recommended in those at risk of severe pneumococcal disease as it protects against infection with more types of bacteria.

What are the contraindications to pneumococcal vaccine?
Only prior serious allergic reactions to one dose are contraindications. Those who have an acute illness should wait till resolution to be vaccinated.

Can these vaccines cause pneumococcal disease?
No. Both PPSV23 and PCV13 contain killed bacteria, which cannot cause pneumococcal disease.


Contributor Information and Disclosures

Jagdish Kathwate*, Monica Madvariya**
*MD Pediatrics. Assistant Professor, Government Medical College, Aurangabad, India. ** MD Pediatrics, Mumbai

First Created : 1/10/2006
Last Updated : 2/29/2016


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