Pneumococcal Vaccine

The pneumococcal vaccine is an injectable vaccine that prevent many types of infectious pneumococcal bacteria. Currently, there are 2 kinds of Pneumococcal vaccines available for use: Pneumococcal conjugate vaccines and Pneumococcal polysaccharide vaccines. Pneumococcal polysaccharide vaccines do not produce optimum immune response in children less than 2 years of age. The pneumococcal conjugate vaccines are advanced vaccines produced by chemical coupling or joining of S. pneumoniae polysaccharides to an immunogenic protein carrier. This enhances the protective antibody production and also induces immunological memory.

Components of pneumococcal vaccines and recommendations:

1. The pneumococcal conjugate vaccines (PCVs)

PCV10 consist of capsular polysaccharides purified from 10 types of pneumococcal bacteria . These polysaccharides are conjugated to a carrier protein, either protein D (an outer membrane protein from Haemophilus influenzae), tetanus toxoid, or diphtheria toxoid. 10-valent PCV10 protects from 10 types of pneumococcal bacteria.

PCV13 consist of capsular polysaccharides purified from 13 types of pneumococcal bacteria . These polysaccharides are conjugated to a carrier protein diphtheria toxoid .13-valent PCV 13 or Prevnar 13®  protects against 13 types of pneumococcal bacteria.

  • Both PCV10 and PCV13 are licensed for routine vaccination of children from 6 weeks to 5 years of age.
  • PCV13 protects infants and older children from 13 serious pneumococcal infections worldwide and is more commonly used.
  • PCV’s are also recommended for adults 19 through 64 years of age who are at increased risk due to smoking,asthma and alcohol consumption. 65 years and older are also highly susceptible to pneumococcal diseases and therefore, can consider vaccination.

2. The pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23)  protects against 23 types of pneumococcal bacteria. It is only recommended for vaccination of persons who fall under high-risk category due to certain medical conditions. It is not used for  routine vaccination  in healthy persons.

Recommended Schedule

Routine vaccination for Pneumococcal Conjugate Vaccines PCV10 and PCV13

  • Minimum age of the recipient should be 6 weeks
  • Any of the  PCV 10 or PCV13 vaccine product can be given as 3 primary doses to infants at 6, 10 and 14 weeks age
  • Booster dose should be given at age 12 through 15 months.

Catch up vaccination  for PCV10 and PCV13

  • Infants 6-12 months old who are not vaccinated in the primary schedule should be given 2 doses at 4 weeks interval followed by 1 booster dose
  • Children 12-23 months should be given 2 doses at 8 weeks interval
  • Children 2 years to 5 years should be given single dose if they missed doses in the primary schedule.

Recommended dosage of PPSV23

  • Minimum age: 2 years
  • PPSV is given at least 8 weeks after the last dose of routine PCV to children aged 2 years or older suffering from anatomic or functional asplenia (including sickle cell disease), HIV infection, cochlear implant or cerebrospinal fluid leak. A booster dose of PPSV should be administered after 5 years to these children.

How are pneumococcal vaccines administered?

The  pneumococcal vaccines are given by an injection into the anterolateral aspect of thigh in infants and the deltoid muscle of children and adults >2 years of age.

Side effects:

Injection site reactions like swelling and pain are more common in children older than 1 year compared to infants. Fever  >39 °C, vomiting and diarrhoea can occur. Hypersensitivity reactions like rash and  facial swelling are also reported in some cases. Nervous system disorders including convulsions are very rare events following vaccination.

Why should we consider Pneumococcal vaccination?

Currently available PCVs are safe and effective against many important types of Pneumococcal bacterial infections. A previous pneumococcal infection does not protect a person from future infections as there are more than 90 types of pneumococcal bacteria that causes disease. Natural immunity gained from one type will not prevent the person from another type.

As per WHO reports, around 500,000 children younger than 5 years die each year due to variety of invasive pneumococcal disorders(IPD). Children falling prey to these pathogenic bacteria mainly belong to children in developing countries. Antibiotics such as penicillin are used for treatment of pneumococcal infections but evolution of antibiotic-resistant pneumococcus raise an alarm worldwide to include preventive measures like vaccination. WHO recommends introduction of PCVs in childhood immunization programmes. High cost of the production of these vaccines is the main deterrent in this much awaited decision. However, this does not minimize the requirement of these vaccines in infants in developing countries like India.

Marketed Pneumococcal Products

Here is the list of WHO pre-qualified vaccine products available in market. Click on name of the product to know more.