Pneumococcal vaccination: Who should be vaccinated?
The Standing Commission on Vaccination (STIKO) at the Robert Koch Institute recommends pneumococcal vaccination on the one hand as a standard vaccination for all infants and young children and for people aged 60 and over:
Children in the first two years of life are particularly at risk of contracting a severe pneumococcal infection. Therefore, the general recommendation for vaccination applies to this age group.
A standard vaccination is a protective vaccination that is recommended by the STIKO for all people in the population or at least for all representatives of a certain age group.
On the other hand, the STIKO recommends vaccination against pneumococci as an indication vaccination for certain risk groups – namely for people of all ages who have an increased risk of coming into contact with pneumococci, contracting the disease and/or developing complications in the event of an illness. This applies to:
- Chronic diseases: e.g. chronic cardiovascular or pulmonary diseases (such as heart failure, asthma, COPD), metabolic diseases (such as diabetes mellitus requiring treatment), neurological diseases (such as seizure disorders).
- increased risk of pneumococcal meningitis either due to a foreign body (e.g. cochlear implant) or due to special anatomical conditions (e.g. cerebrospinal fluid fistula*)
In addition, the STIKO also advises pneumococcal vaccination in cases of increased occupational risk. These include:
- People who have an increased risk of contracting the disease, for example, due to welding and cutting metals: Welding or metal smoke favors pneumonia. At the very least, vaccination can protect against pneumococcal pneumonia.
What are pneumococci?
So-called invasive pneumococcal diseases are particularly dangerous. In these cases, the bacteria spread in otherwise sterile body fluids. In this way, for example, a life-threatening meningitis or sepsis (“blood poisoning”) can develop due to pneumococci.
You can read more about this in the article Pneumococcal infection.
Types of pneumococcal vaccines
As soon as a pneumococcal vaccine has been injected into a patient’s muscle, his immune system reacts by producing specific antibodies against these components (active vaccination). These antibodies then also fight off the bacteria in a “real” pneumococcal infection.
Pneumococcal polysaccharide vaccine (PPSV)
Pneumococcal conjugate vaccine (PCV).
This type of vaccine is a more recent development. Here, the characteristic envelope components (polysaccharides) of different pneumococcal serotypes are bound to a carrier substance (a protein). This improves the immune response and thus the effect of the vaccination.
The following pneumococcal conjugate vaccines are currently available in Germany:
- PCV13: It is based on the envelope components of 13 pneumococcal serotypes and can be administered between six weeks and 17 years of age.
- PCV15: This vaccine protects against 15 pneumococcal serotypes. Medical professionals can vaccinate it starting at six weeks of age.
- PCV20: This 20-valent conjugate vaccine protects against even more pneumococcal serotypes. It is approved for adults only.
Pneumococcal vaccination: How often and when to vaccinate?
Standard vaccination against pneumococcus in children.
The STIKO recommends pneumococcal vaccination for all infants from the completed second month of life,. The vaccination schedule is based on whether a child was born mature or premature (i.e., before the completed 37th week of pregnancy).
- 3+1 vaccination schedule for premature babies: 4 doses of conjugate vaccine at 2, 3, 4, and 11 to 14 months of age.
A conjugate vaccine is recommended as pneumococcal vaccine because the polysaccharide vaccine is not sufficiently effective in children under two years of age.
Catch-up vaccination
For children between the ages of 12 and 24 months who have not yet been vaccinated against pneumococci, the STIKO recommends a catch-up vaccination with two doses of a conjugate vaccine. There should be an interval of at least eight weeks between the two vaccination dates.
Standard vaccination against pneumococci from 60 years of age
According to the STIKO, people who are 60 years of age or older and do not belong to either the target group for indication vaccination (see below) or that for vaccination due to occupational risk (see below) should receive a dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) as standard.
Indication vaccination against pneumococci
Special recommendations for pneumococcal vaccination apply to people of all ages who are at increased risk for severe pneumococcal disease because of an underlying condition:
1. people with congenital or acquired immunodeficiency.
People who suffer from congenital or acquired immunodeficiency receive what is called sequential vaccination with different vaccines:
- Another pneumococcal vaccination follows after six to twelve months, but now with the polysaccharide vaccine PPSV23. However, this may only be given from the age of two years.
This vaccination protection should be refreshed with the polysaccharide vaccine at a minimum interval of six years.
You can read more about vaccination in a weakened immune system in the article Immunosuppression and Vaccination.
2. people with other chronic diseases
- Children between two and 15 years: sequential vaccination as described above (first PCV13, after 6 to 12 months PPSV23).
- Patients 16 years and older: one vaccination with polysaccharide vaccine PPSV23.
In all cases, pneumococcal vaccination with PPSV23 vaccine should be repeated at a minimum interval of six years.
Children under two years of age may only receive conjugate vaccine.
3. people at increased risk for meningitis.
In the case of cochlear implants, physicians administer the vaccination before insertion of the implant, if possible.
Pneumococcal vaccination in case of occupational risk
Anyone who has an increased risk of (severe) pneumococcal disease due to their job should be vaccinated against pneumococcus with the polysaccharide vaccine PPSV23. As long as this risk exists (i.e. the corresponding activity is performed), it is advisable to repeat the vaccination at least every six years.
Often, pneumococcal vaccination causes reactions at the injection site, such as redness, swelling and pain. Such discomfort is caused by the vaccine activating the immune system (but this does not mean that in the absence of such local reactions the vaccination is not effective!)
In infants and young children, high fever can trigger a febrile convulsion.
Only rarely does the pneumococcal vaccine cause more serious side effects, for example allergic reactions (such as hives).
You can learn more about the possible side effects of a specific pneumococcal vaccine from your health care provider.
Pneumococcal vaccination: costs
So, for example, if the doctor gives your baby the recommended doses of pneumococcal conjugate vaccine, your health insurance will cover the cost. Pneumococcal vaccination for those over 60 with PPSV23 or sequential vaccination for congenital immunodeficiency, for example, is also a health insurance benefit.
Vaccine in short supply: Who really needs it?
At such times, it is important that physicians can continue to vaccinate at-risk groups against pneumococcus in particular. This is because they have an increased risk of pneumococcal disease becoming severe and fatal.
In the event of a PPSV23 shortage, the RKI therefore recommends that medical professionals give priority to administering the remaining vaccine to the following groups of people:
- People with immunodeficiency
- People 70 years of age and older (to complete sequential vaccination)
- People with chronic heart or respiratory diseases
As soon as sufficient PPSV23 is again available for pneumococcal vaccination, the vaccination recommendations of the Standing Commission on Vaccination as described above will again apply here.
