Pneumococcal disease

The risk of invasive pneumococcal disease is much higher in infants and older people and more frequent in individuals with predisposing conditions. Mortality is highest in patients with underlying medical conditions.

PREVENAR 13® is one of the childhood Immunisation Schedule vaccines for children less than 5 years. PREVENAR 13® is also recommended and funded for individuals post-haematopoietic stem cell transplantation; post-chemotherapy; pre- or post-solid organ transplantation; pre- or post-splenectomy; or with functional asplenia; cochlear implant; complement deficiency (acquired or inherited); primary immunodeficiency; or on renal dialysis or who are HIV-positive. Other high-risk children aged 18 months to under 18 years who have previously received four doses of PCV10 can also receive PREVENAR 13®.

PNEUMOVAX 23® is recommended and funded for individuals pre- or post-splenectomy or with functional asplenia and other high-risk children aged 2 years to under 18 years.

For further information on pneumococcal disease and a summary of pneumococcal vaccine recommendations (funded and unfunded) and schedules please refer to Chapter 15 in the on-line (or electronic) Immunisation Handbook 2014.

Older children* and adults
All older children and adults at higher risk of pneumococcal are recommended to have one dose of PREVENAR 13® (conjugate pneumococcal vaccine) followed by one dose of PNEUMOVAX 23® (polysaccharide pneumococcal vaccine). (3)

Older children and adults at higher risk of pneumococcal disease are:

  • individuals of any age pre- or post-splenectomy or with functional asplenia

  • immune-competent individuals at increased risk of pneumococcal disease or its complications because of chronic illness (eg, chronic cardiac, renal, liver or pulmonary disease, diabetes or alcoholism)

  • individuals with cerebrospinal fluid leak

  • immune-compromised individuals at increased risk of pneumococcal disease (eg, those with nephrotic syndrome, multiple myeloma, lymphoma and Hodgkin’s disease, or those who are immunosuppressed following organ transplantation)

  • individuals with HIV infection

  • individuals who have had one episode of invasive pneumococcal disease

  • individuals with cochlear implants

  • individuals aged 65 years and older

* Older children are those aged 5 years to under 18 years
NB: Not all of the above groups are eligible for funded pneumococcal vaccinations.

PREVENAR 13®
PREVENAR 13® is used for primary and booster vaccination to protect against disease caused by 13 types of Streptococcus pneumoniae. The vaccine is approved for use in adults and children from 6 weeks of age.

Conjugate pneumococcal vaccines show good immunogenicity results in older adults, and studies are currently underway on effectiveness. PCV13 was approved for use in adults aged 50 years and older by the US FDA in October 2011 on the data supporting clinical benefit from studies indicating superior immune responses over the 23PPV.(3) A prior dose of a polysaccharide vaccine 23PPV is likely to attenuate the response to a subsequent dose of a conjugate (PCV13). Hence PCV13 is likely to be of clinical benefit in at-risk older adult age groups and when used it is preferable to offer it prior to 23PPV to avoid potential hyporesponsiveness associated with the use of 23PPV.(4) There is a recommended two month interval between giving the PCV13 prior to the 23PPV. If a 23PPV has been given previously it is recommended to wait one year before giving the PCV13 to avoid interference between the two vaccines.

PNEUMOVAX® 23
It has been demonstrated, particularly in older people over 65 years with chronic lung disease, that giving both influenza and pneumococcal polysaccharide 23-valent (23PPV) vaccines during the influenza season has an additive benefit in reducing hospitalisations for pneumonia and death.

The 23PPV vaccine offers some protection against invasive pneumococcal disease in the elderly population although a reduced level of protection in the high-risk elderly. There is limited evidence to support efficacy against pneumonia in older adults in the community. The vaccine appears to provide some protection against all cause pneumonia and pneumococcal pneumonia in nursing home residents.

Protection from the polysaccharide type of pneumococcal vaccine is relatively short lasting. The general consensus is that most high-risk children and adults will require a second vaccination after 5 years.(1-2) The polysaccharide pneumococcal vaccine should not be given more than 2–3 times in a lifetime.

Coadministration of pneumococcal and influenza vaccines

PREVENAR 13® and influenza vaccine
Coadministration of PREVENAR 13® and an inactivated influenza vaccine to children aged 6 months to 5 years has been associated with an increased risk of fever. If a child is likely to be at increased risk of febrile convulsions then it is recommended to separate the delivery of the two vaccines by at least two days.

Co-administration of PREVENAR 13® and influenza vaccine does result in lower influenza mean antibody titres but it is still considered satisfactory from both a safety and immunogenicity perspective.(6)

PNEMUOVAX® 23 and influenza vaccine
Coadministration of PNEUMOVAX® 23 influenza vaccine is safe and is not associated with increased rates of side effects as long as given in separate injection sites.(5) If the vaccines are not given at the same time there is no need for any minimum interval between doses.

For the PREVENAR 13® and PNEUMOVAX 23® Datasheets please refer to the Medsafe website www.medsafe.govt.nz.

References

  1. Jackson LA. Pneumococcal polysaccharide vaccines. In Plotkin S, Orenstein W, and Offit P, editors. Vaccines. 6th ed. London: W.B. Saunders; 2013. p. 1200-31.
  2. Konradsen HB. Quantity and avidity of pneumococcal antibodies before and up to five years after pneumococcal vaccination of elderly persons. Clin Infect Dis. 1995;21(3): p. 616-20.
  3. Centres for Disease Control and Prevention. Licensure of 13-valent pneumococcal conjugate vaccine for adults aged 50 years and older. MMWR Morb Mortal Wkly Rep. 2012;61(21): p. 394-395.
  4. Jackson LA, Gurtman A, Rice K, Pauksens K, Greenberg RN, Jones TR, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine. 2013;31(35): p. 3585-3593.
  5. Honkanen PO, Keistinen T, Kivela SL. Reactions following administration of influenza vaccine alone or with pneumococcal vaccine to the elderly. Arch Intern Med. 1996;156(2): p. 205-8.
  6. Gladstone RA, Jefferies JM, Faust SN, Clarke SC, Pneumococcal 13-valent conjugate vaccine for the prevention of invasive pneumococcal disease in children and adults. Expert Rev Vaccines. 2012;11(8): p. 889-902.