There are two different types of pneumococcal vaccines – pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV).
Pneumococcal polysaccharide vaccine (PPV)
- 23-valent pneumococcal polysaccharide vaccine (23vPPV)
23vPPV contains capsular polysaccharides derived from the 23 most frequent or most virulent types of S. pneumonia. PPV induces significant immune responses in immunocompetent adults, including the elderly, with no substantial differences in immune response between older and younger subjects, but poor responses in the immunocompromised15. 23vPPV is poorly immunogenic for most serotypes in children aged <2 years and does not induce immune memory.
Pneumococcal conjugate vaccines (PCV)
The immunogenicity of capsular polysaccharides can be enhanced by conjugation to carrier proteins.
PCV formulations vary in the number of pneumococcal serotypes included and the conjugating proteins used. Pneumococcal conjugate vaccines are immunogenic in young infants and can induce an immune memory response.
- 10-valent pneumococcal conjugate vaccine (10vPCV) – registered for use in Australia since 2009 and is included under the NIP.
- 13-valent pneumococcal conjugate vaccine (13vPCV) – registered in Australia since 2010, and used in the NIP since July 2011
Who should receive pneumococcal vaccination
Pneumococcal vaccination is recommended for all children < 5 years of age and is funded by the National Immunisation Program. Children > 5 years and adults with medical conditions associated with an increased risk of invasive pneumococcal disease should receive pneumococcal vaccinations. Non-indigenous adults ≥ 65 years and Indigenous adults ≥ 50 years should routinely be offered pneumococcal vaccination. The type and number of doses of pneumococcal vaccination vary in different age groups and risk groups. See the Australian Immunisation Handbook for further details.
Dosage and administration
The dose of pneumococcal conjugate vaccines (10vPCV, 13vPCV) is 0.5 mL, to be given by IM injection, in the opposite limb to other injectable vaccines, if possible.
The dose of pneumococcal polysaccharide vaccine (23vPPV) is 0.5 mL, to be given by either IM or SC injection, in the opposite limb to other injectable vaccines, if possible. The IM route is preferred, as a 3-fold greater rate of injection site reactions is found following administration of 23vPPV by the SC route.15 A vaccine dose administered subcutaneously does not need to be repeated.
10vPCV (Synflorix) is registered for use in infants and children aged 6 weeks up to 5 years.
13vPCV (Prevenar 13) is registered for use in infants and children aged 6 weeks up to 17 years and adults aged ≥50 years.
23vPPV (Pneumovax 23) is registered for use in children aged ≥2 years and in adults.
Pregnancy and breastfeeding
23vPPV is not routinely recommended for pregnant or breastfeeding women – deferral of vaccination with 23vPPV until after delivery is recommended unless there is an increased risk of IPD. 23vPPV may be given to breastfeeding women.
Data on use the use of 10vPCV and 13vPCV during pregnancy or lactation are not available.
- Black S, Eskola J, Whitney C, Shinefield H. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
- Centers for Disease Control and Prevention (CDC). Pneumococcal disease. In: Atkinson W, Wolfe C, Hamborsky J, eds. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, D.C.: Public Health Foundation, 2011.
- Kadioglu A, Weiser JN, Paton JC, Andrew PW. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nature Reviews Microbiology 2008;6:288-301.
- Weinberger DM, Harboe ZB, Sanders EA, et al. Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis. Clinical Infectious Diseases 2010;51:692-9.
- World Health Organization (WHO). 23-valent pneumococcal polysaccharide vaccine: WHO position paper. Weekly Epidemiological Record 2008;83:373-84.
- Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococcal serotypes. The Lancet Infectious Diseases 2005;5:83-93.
- Roche PW, Krause V, Cook H, et al. Invasive pneumococcal disease in Australia, 2006. Communicable Diseases Intelligence 2008;32:18-30.
- File TM, Jr., Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgraduate Medicine 2010;122:130-41.
- Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. New England Journal of Medicine 2001;344:403-9.
- Musher DM. Streptococcus pneumoniae. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone, 2010.
- Pilishvili T, Zell ER, Farley MM, et al. Risk factors for invasive pneumococcal disease in children in the era of conjugate vaccine use. Pediatrics 2010;126:e9-17.
- Menzies R, Turnour C, Chiu C, McIntyre P. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Communicable Diseases Intelligence 2008;32 Suppl:S2-67.
- van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. The Lancet 2009;374:1543-56.
- Jackson LA, Neuzil KM. Pneumococcal polysaccharide vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
- Cook IF, Pond D, Hartel G. Comparative reactogenicity and immunogenicity of 23 valent pneumococcal vaccine administered by intramuscular or subcutaneous injection in elderly adults. Vaccine2007;25:4767-74.