Pneumococcal disease

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. Some types are more likely to cause infection in particular parts of the body than others, such as the sinuses (sinusitis), the ear (otitis media/middle ear infection), or the lungs (pneumonia). Invasive pneumococcal disease is the most serious type of pneumococcal disease and occurs when the bacteria pass into the blood (septicaemia), inflame the membranes around the brain (meningitis), infect the heart muscle, or infect other sites in the body such as joints or the gut (abdomen).

Children under 5 years of age and the elderly are more at risk of getting pneumococcal disease. Babies aged under 1 year, Māori, Pacific Peoples, and older adults have the highest risk of serious 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. 

SYNFLORIX® is the free pneumococcal vaccine on the routine Immunisation Schedule at the 6 weeks, 3 months, 5 months and 15 months of age immunisation visits. Synflorix will also be used to catch-up missed immunisation doses up to 5 years of age. PREVENAR 13® and PNEUMOVAX®23 are the free pneumococcal vaccines on the ‘special groups’ Schedule, for children and adults with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule. Doctors may recommend PREVENAR 13® and/or PNEUMOVAX®23 for people with a medical condition that is not listed on the Pharmaceutical Schedule, but the vaccines will not be free. The vaccines can be purchased from Healthcare Logistics for ineligible individuals.

Co-administration of pneumococcal and influenza vaccines

Influenza vaccine can be administered with pneumococcal vaccines. However, the vaccines must be given at different injection sites.

Fever is a common adverse event in children after vaccination. Convulsions associated with fever can occur in susceptible children. Around 3–8 children in 100 aged under 7 years will experience a febrile convulsion, most likely when aged between 16 and 30 months. In one study, children aged 6–23 months are two to three times more likely to develop a fever of 38°–39°C during the first 24 hours after receiving influenza and PCV13 (PREVENAR 13®) vaccines at the same visit compared with children who received the vaccines on separate days. Around one in 10 adults have an increased risk of experiencing fatigue, headache and/or body aches and pains during the 14 days after receiving influenza and PCV13 vaccines at the same visit. Around two in 10 adults have an increased risk of redness or pain at the site of one or both injection sites when receiving influenza and 23PPV (PNEUMOVAX®23) vaccines concurrently. 

Parents/guardians whose children are recommended to receive both influenza vaccine and PCV13 should be advised of the possible increase in risk of fever following concurrent administration of these vaccines. Separating administration of these vaccines by two days can be offered, but is not essential. 

For further information visit:

The Immunisation Advisory Centre

Chapter 15 in the Immunisation Handbook 2017

Medsafe

References

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  • Institute of Environmental Science and Research Ltd (ESR). Invasive pneumococcal disease in New Zealand, 2014. Porirua: ESR; 2016.
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SYNFLORIX® (pneumococcal polysaccharide conjugate vaccine, 10-valent): Single-dose 0.5 mL pre-filled glass syringe. Indications: For the prevention of pneumococcal disease caused by 10 serotypes of Streptococcus pneumoniae in children from 6 weeks to under 5 years of age. Contraindications: Hypersensitivity to any component of the vaccine. Precautions: Administration of Synflorix should be postponed in individuals suffering from acute moderate or severe febrile illness. Interactions: Synflorix can be given with any of the following monovalent or combination vaccines: diphtheria, tetanus, acellular or whole cell pertussis, Haemophilus influenzae type b, inactivated poliomyelitis, hepatitis B, meningococcal serogroup A, C, Y, W135, measles, mumps, rubella, rotavirus and varicella. Adverse reactions: Fever, local reactions, decreased appetite, irritability, drowsiness. Dosage: Children from 6 weeks to under 5 years of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose 0.5 mL pre-filled glass syringe in packs of 10. Cold chain: Store between +2°C to +8°C. Store in the original package in order to protect form light. Sponsor: GlaxoSmithKline NZ Limited.

PREVENAR 13® (pneumococcal polysaccharide conjugate vaccine, 13-valent): Single-dose 0.5 mL pre-filled glass syringe. Indications: For the prevention of pneumococcal disease caused by 13 serotypes of Streptococcus pneumoniae in adults and children from 6 weeks of age. Contraindications: Hypersensitivity to the active substances or to any of the excipients, or to diphtheria toxoid Allergic reaction or anaphylactic reaction following prior administration of Prevenar. Precautions: Administration of Prevenar 13 should be postponed in individuals suffering from acute moderate or severe febrile illness. Interactions: Prevenar 13 can be given with any of the following vaccine antigens, either as monovalent or combination vaccines: diphtheria, tetanus, acellular or whole cell pertussis, Haemophilus influenzae type b, inactivated poliomyelitis, hepatitis B, meningococcal serogroup A, C, Y, W, measles, mumps, rubella and varicella. Prevenar 13 can be given with influenza vaccine. Adverse reactions: Fever, local reactions, diarrhoea, vomiting, decreased appetite, irritability, drowsiness, headache, generalised muscle or joint pain, rash. Dosage: Adults and children from 6 weeks of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose 0.5 mL pre-filled glass syringe in pack of 1 or 10. Cold chain: Store between +2°C to +8°C. Sponsor: Pfizer New Zealand Limited.

PNEUMOVAX® 23 (pneumococcal vaccine polyvalent): Single-dose 0.5 mL pre-filled syringe. Indications: For the prevention of pneumococcal disease caused by 23 serotypes of Streptococcus pneumoniae in adults and children from 2 years of age. Contraindications: Hypersensitivity to any component of the vaccine. Precautions: Administration of Pneumovax 23 should be postponed in individuals suffering from acute febrile respiratory illness. If the vaccine is used in persons receiving immunosuppressive therapy, the expected serum antibody response may not be obtained and potential impairment of future immune responses to pneumococcal antigens may occur. Interactions: Pneumovax 23 can be given with influenza vaccine. Adverse reactions: Fever, local reactions. Dosage: Adults and children from 2 years of age: 0.5 mL. Administration: IM or SC injection. Presentation: Single-dose 0.5 mL pre-filled syringe. Cold chain: Store between +2°C to +8°C. Sponsor: Merck Sharp & Dohme (New Zealand) Limited.