Pneumococcal Vaccination: Who Needs It?
There are currently 2 types of pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) and pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®).
- PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and people 6 years or older with certain risk factors.
- PPSV is recommended for all adults who are 65 years and older and for persons 2 through 64 years of age who are at high risk for pneumococcal disease.
Does my child need the PCV13 vaccine?
- Infants and Children younger than 2 Years of Age
- PCV13 is routinely given to infants as a series of 4 doses, one dose at each of these ages: 2 months, 4 months, 6 months, and 12 through 15 months.
- Children who miss their shots or start the series later should still get the vaccine. The number of doses recommended and the intervals between doses will depend on the child's age when vaccination begins. Ask your healthcare provider for details.
- Children 2 through 5 Years of Age
- Healthy children 24 months through 4 years of age who are unvaccinated or have not completed the PCV13 series should get 1 dose.
- Children 24 months through 5 years of age with medical conditions such as the following should get 1 or 2 doses of PCV13 if they have not already completed the 4-dose series. Ask your healthcare provider for details.
- Sickle cell disease
- A damaged spleen or no spleen
- Cochlear implant(s)
- Cerebrospinal fluid (CSF) leaks,
- HIV/AIDS or other diseases that affect the immune system (such as diabetes, cancer, or liver disease),
- Chronic heart or lung disease,
- Children who take medications that affect the immune system, such as chemotherapy or steroids.
- Children 6 through 18 Years of Age
- A single dose of PCV13 should be given to children 6 through 18 years of age with certain medical conditions (i.e., sickle cell disease, HIV-infection, or other immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leaks) who have not previously received PCV13, regardless of whether they have previously received the 7-valent pneumococcal conjugate vaccine (PCV7) or the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Ask your healthcare provider for details.
PCV13 may be given at the same time as other vaccines, except for PPSV23 and meningococcal conjugate vaccine. For children who are recommended to receive PPSV23 in addition to PCV13, PPSV23 should be administered at least 8 weeks after the child has received the final dose of PCV13. Children with a damaged spleen or no spleen should complete the PCV13 recommended series before getting meningococcal conjugate vaccine.
For additional details, consult the PCV Vaccine Information Statement, the Child Immunization Schedule, the Licensure of a PCV13 for Use of PCV13 Among Children —ACIP, 2010, Mar 2010.
- All adults 65 years of age or older who have not previously received PCV13.
- Adults 19 years of age or older with certain medical conditions, and who have not previously received PCV13. Medical conditions include:
- Cerebrospinal fluid (CSF) leaks
- Cochlear implant(s)
- Sickle cell disease and other hemaglobinopathies
- Functional or anatomic asplenia
- Congenital or acquired immunodeficiencies
- HIV infection
- Chronic renal failure
- Nephrotic syndrome
- Hodgkin disease
- Generalized malignancy
- Long-term immunosuppressive therapy
- Solid organ transplant
- Multiple myeloma
- Adults who are 65 years of age or older and who have not previously received PCV13, should receive a dose of PCV13 first, followed 6 to 12 months later by a dose of PPSV23. If you have already received one or more doses of PPSV23, the dose of PCV13 should be given at least 1 year after you got your most recent dose of PPSV23.
- Adults 19 years or older with one of the above listed conditions who have not received any pneumococcal vaccine, should get a dose of PCV13 first and should also continue to receive the recommended doses of PPSV23. Ask your healthcare provider for details.
- Adults 19 years or older who have previously received one or more doses of PPSV23, and have one of the above listed conditions should also receive a dose of PCV13 and should continue to receive the remaining recommended doses of PPSV23. Ask your healthcare provider for details.
- All adults 65 years of age or older.
- Anyone 2 through 64 years of age who has a long-term health problem such as: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant.
- Anyone 2 through 64 years of age who has a disease or condition that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no spleen; organ transplant.
- Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
- Any adult 19 through 64 years of age who is a smoker or has asthma.
- Residents of nursing homes or long-term care facilities.
PPSV23 may be less effective for some people, especially those with lower resistance to infection.
But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease.
Children who often get ear infections, sinus infections, or other upper respiratory diseases, but who are otherwise healthy, do not need to get PPSV23 because it is not effective against those conditions.
For additional details, consult the PPSV23 Vaccine Information Statement, the Adult Immunization Schedule, and the ACIP Recommendations for Use of Pneumococcal Vaccines, Sept 2010.
Are pneumococcal vaccines effective?
Yes. Studies done on 7-valent pneumococcal conjugate vaccine (PCV7), which was licensed by FDA in late 2000, showed the vaccine to be highly effective in preventing invasive pneumococcal disease in young children. The 13-valent pneumococcal conjugate vaccine, also known as Prevnar 13® or PCV13, which was licensed by FDA in February 2010, provides protection against infections caused by a greater variety of pneumococcal serotypes (“strains”). PCV13 is similar to PCV7 but includes 6 additional serotypes. This means that it provides protection against infections caused by a greater variety of pneumococcal serotypes. Studies have shown that PCV13 causes the body’s immune system to create protective antibodies, which help fight the pneumococcal bacteria, similar to PCV7.
In a study including 37,000 infants in California, PCV7 was over 90% effective in preventing invasive disease caused by serotypes included in the vaccine. The children who received the vaccine also had 7% fewer episodes of otitis media and a 20% decrease in the number of tympanostomy tubes (ear tubes) placed. The vaccine was also shown to decrease the number of episodes of pneumonia.
CDC conducted a study soon after PCV7 was licensed and found that the vaccine was 96% effective against pneumococcal disease (caused by the 7 serotypes in the vaccine) in healthy children who received one dose or more and 81% effective in children with medical conditions that put them at risk of pneumococcal disease. The vaccine was also highly effective at preventing pneumococcal disease caused by antibiotic-resistant serotypes included in the vaccine. Studies evaluating effectiveness of PCV13 demonstrated similar benefits.
Since routine vaccine introduction in the United States, rates of invasive pneumococcal disease caused by the seven serotypes included in the vaccine have declined by 99%. Rates of invasive pneumococcal disease caused by some serotypes not in the PCV7 vaccine have increased since PCV7 vaccine introduction. However, these increases have been small compared to the decreases in vaccine type serotypes. Also, the main serotypes causing the increases are covered by PCV13, and the rates of disease caused by these serotypes have already declined since PCV13 replaced PCV7 for routine use among children.
In late 2011, FDA licensed PCV13 for use among adults 50 years of age or older. In a study including approximately 85,000 adults 65 years or older in the Netherlands, PCV13 was 75% effective at preventing invasive pneumococcal disease and 45% effective at preventing pneumococcal pneumonia caused by the serotypes included in the vaccine.
Pneumovax®, the pneumococcal polysaccharide vaccine that includes 23 serotypes, has been shown to be 50-85% effective in preventing invasive disease caused by those 23 serotypes in adults with healthy immune systems.
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