Pneumococcal vaccination is a standard vaccination (regular vaccination) performed by means of an inactivated vaccine. Since 1998, a 23-valent polysaccharide vaccine (PPSV23) (in the meantime also a 13-valent pneumococcal conjugate vaccine PCV 13) has been recommended by the STIKO for indication and standard vaccination. Pneumococcal vaccination is increasingly becoming a routine protective vaccination for seniors. The bacterium Streptococcus pneumoniae – also called pneumococcus – is considered the main cause of pneumonia (lung inflammation) and can further lead to sinusitis (inflammation of the sinuses), otitis media (inflammation of the middle ear) or meningitis (meningitis). The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on pneumococcal vaccination:
Indications (areas of application)
- S: Persons ≥ 60 years [vaccination with the 23-valent polysaccharide vaccine (PPSV23), if necessary, repeat vaccinations with PPSV23 at intervals of at least 6 years after individual indication].
- I: Patients (due toincreased individual risk/indication vaccinations): children, adolescents and adults with an underlying disease such as:
- Congenital or acquired immunodeficiencies with residual T and/or B cell function, such as: [Sequential vaccination with 13-valent conjugate vaccine (PCV13) followed by PPSV23 at 6-12 months, with PPSV23 given only after 2 years of age. * * ]
- T-cell deficiency or impaired T-cell function.
- B-cell or antibody deficiency (e.g., hypogammaglobulinemia).
- Deficiency or dysfunction of myeloid cells (e.g., neutropenia, chronic granulomatosis, leukocyte adhesion defects, signal transduction defects)
- Complement or properdeficiency.
- Functional hyposplenism (e.g., in sickle cell anemia), splenectomy* , or anatomic asplenia.
- Neoplastic diseases
- HIV infection
- After bone marrow transplantation
- Immunosuppressive therapy* (e.g. due toorgan transplantation or autoimmune disease).
- Immunodeficiency in chronic renal failure, nephrotic syndrome or chronic liver failure.
- Other chronic diseases, such as: [Individuals 16 years of age and older receive vaccination with PPSV23. Individuals 2-15 years of age receive sequential vaccination with PCV13 followed by PPSV23 after 6-12 months. * * ]
- Anatomic and foreign body-associated risks for pneumococcal meningitis, such as: [Sequential vaccination with PCV13 followed by PPSV23 at 6-12 months, with PPSV23 not to be given until 2 years of age. * * ]
- Cerebrospinal fluid fistula – dura leak through which cerebrospinal fluid (“nervous fluid”) can leak into the surrounding area.
- Cochlear implant* – hearing prosthesis for people with severe to profound hearing loss (complete deafness) or even when the inner ear no longer functions adequately; electronic medical device that takes over the function of the damaged parts of the inner ear to transmit audio signals to the brain
- B: Occupational activities such as welding and cutting metals that result in exposure to metal fumes, including metal oxide welding fumes.
- Congenital or acquired immunodeficiencies with residual T and/or B cell function, such as: [Sequential vaccination with 13-valent conjugate vaccine (PCV13) followed by PPSV23 at 6-12 months, with PPSV23 given only after 2 years of age. * * ]
* Vaccination preferably before intervention* * Due to the limited duration of vaccine protection, vaccination with PPSV23 should be repeated in all three risk groups with a minimum interval of 6 years. Legend
- S: Standard vaccinations with general application.
- I: Indication vaccinations for risk groups with individually (not occupationally) increased risk of exposure, disease or complications and for the protection of third parties.
- B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Health and Safety Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of occupational activities.
Note: Currently, Pneumovax 23 should be used primarily for patients with immunodeficiency, seniors from the age of 70 years and patients with chronic respiratory diseases.
Contraindications
- Persons with acute illnesses requiring treatment.
- Allergy to vaccine components (see manufacturer’s supplements).
Implementation
- Congenital or acquired immunodeficiency or immunosuppression (I): sequential vaccination with the 13-valent conjugate vaccine (PCV13) followed by PPSV23 at 6-12 months, with PPSV23 given only after 2 years of age. * *
- Other chronic diseases (I): individuals aged 16 years and older receive vaccination with PPSV23, and individuals aged 2-15 years receive sequential vaccination with PCV13 followed by PPSV23 after 6-12 months. * *
- Anatomic and foreign body-associated risks for pneumococcal meningitis (I): sequential vaccination with PCV13 followed by PPSV23 at 6-12 months, with PPSV23 given only after 2 years of age. * *
- Occupational activities such as welding and cutting metals that result in exposure to metal fumes, including metal oxide welding fumes: Vaccination with PPSV23 and repeat vaccination with PPSV23 with a minimum interval of 6 years, as long as exposure continues.
- Infants at risk up to and including 4 years of age should be vaccinated with pneumococcal conjugate vaccine (10-valent vaccine (PCV10) or 13-valent vaccine (PCV13)).
- From the age of 5 years, vaccination can be done with the 13-valent pneumococcal conjugate vaccine or the 23-valent polysaccharide vaccine.
- For persons ≥ 60 years: vaccination with the 23-valent polysaccharide vaccine (PPSV23), if necessary, repeat vaccinations with PPSV23 at intervals of at least 6 years after individual indication.
- Repeat vaccinations: Due to the limited duration of vaccine protection, the STIKO considers repeat vaccinations with PPSV23 at a minimum interval of 6 years from a medical-epidemiological point of view for all mentioned groups generally useful. However, according to the PPSV23 package insert, “healthy adults should not be routinely revaccinated.” In contrast, according to the technical information, repeat vaccination “may be considered in persons at increased risk for severe pneumococcal disease.” This regularly applies to persons in categories “I” and “B.” For seniors not in either of these categories, the indication must be considered on an individual basis. Patients are to be informed of the stronger reactogenicity of the repeat vaccination compared to the initial vaccination, but also of the possible loss of vaccination protection after failure to repeat vaccination.
* * Due to the limited duration of vaccine protection, vaccination with PPSV23 should be repeated in all three risk groups with a minimum interval of 6 years. Pneumococcal conjugate vaccine (contains components of the capsule of the pathogen in an altered form; 13-valent conjugate vaccine; PCV13) is used in:
- In unvaccinated patients who are vaccinated because of immunodeficiency or chronic kidney disease, vaccination should be given first with the conjugate vaccine.
- Basic immunization:
- Mature infants receive a total of 3 doses of vaccine at 2, 4 and 11-14 months of age (so-called 2+1 vaccination schedule). There should be an interval of 2 months between the 1st and 2nd doses and a minimum interval of 6 months between the 2nd and 3rd doses.
- Premature infants (birth before the completed 37th week of pregnancy) should be vaccinated with a total of 4 vaccine doses at 2, 3, 4 and 11-14 months of age (3+1 vaccination schedule).
- Infants aged twelve months to two years receive two vaccinations at intervals of two months.
- Repeat vaccination: until the 2nd birthday.
Pneumococcus polysaccharide vaccine (contains components of the capsule of the pathogens; 23-valent polysaccharide vaccine; PPSV23) is used for:
- In children aged 2 years and older, adolescents, and adults, one vaccination is sufficient; in children previously vaccinated with conjugate vaccine (see above), the minimum interval for subsequent vaccination with polysaccharide vaccine is 2 months
- Standard vaccination from the age of 60
- A booster vaccination can be given after 6 years in adults and after 3 years in children if the indication continues.
Implementation of sequential pneumococcal indication vaccination from the age of 2 years, taking into account the previous vaccination status.
| Vaccination status | Recommended vaccination schedule for sequential vaccination. | Repeat PPSV23 vaccination at least 6 years apart from the last PPSV23 vaccination. | |
| 1. vaccination | 2nd vaccination | ||
| No vaccination | PCV13 | PPSV23 at 6-12 month intervals* . | Yes |
| PCV13 | PPSV23 at 6-12 month intervals. | N/A | yes |
| PCV7 or PCV10 | PCV13 | PPSV23 at 6-12 month intervals* . | Yes |
| PPSV23 <6 years ago | PCV13 12 months apart | PPSV23 at 6-year interval from the previous PPSV23 vaccination. | Yes |
| PPSV23 ≥ 6 years ago | PCV13 | PPSV23 at 6-12 month intervals* . | Yes |
| PCV13 + PPSV23 | N/A | N/A | yes |
* PPSV23 (23-valent polysaccharide vaccine) can be given no earlier than 2 months after PVC13 vaccine (13-valent conjugate vaccine) (e.g., if vaccination is given before planned immunosuppressive therapy); a longer interval of 6-12 months is immunologically more favorable.
Efficacy
- Reliable efficacy against septic courses in invasive infections.
- Satisfactory to insufficient efficacy against other forms
- Vaccination protection circa from the 2nd / 3rd week after vaccination.
- Duration of vaccination protection individually very different, about 3-5 years.
Possible side effects / vaccination reactions
- There are no known side effects with the vaccine for infants and young children.
- With the adult vaccine, local reactions such as redness and swelling, or very rarely allergic reactions may occur.
