There are two kinds of pneumococcal vaccine:
- Pneumococcal polysaccharide vaccine (PPV)
- Pneumococcal conjugate vaccine (PCV)
The first PPV was approved in the USA in 1977 containing purified protein from 14 types of pneumococcal bacteria. In 1983 a PPV vaccine with the purified protein from 23 pneumococcal bacteria was approved (known as PPSV23). The PPSV23 is approved for use in adults and patients with specific risk factors who are at least 2 years of age.
The first PCV was approved in the USA in 2000 for use in infants and young children - aged six weeks to 5 years - for the prevention of pneumococcal disease. This vaccine is commonly known as PCV7.
Both PPSV23 and PCV7 are made from inactivated bacteria. PPSV23 contains long chains of polysaccharide (sugar) molecules that exist on the surface capsule of the bacteria. 88% of invasive pneumococcal diseases are caused by the 23 types of pneumococci that PPSV23 targets - in other words, PPSV23 helps protect people from 88% of all invasive pneumococcal diseases.
PCV7 contains purified capsular polysaccharide of 7 types of bacteria joined (conjugated) to a harmless type of diphtheria toxin.
In 2009 a 10-valent pneumococcal conjugate vaccine (PCV10) covering the 7 serotypes in PCV7 plus three extra serotypes 1, 5 and 7F was licensed for use in infants and children up to the age of 2 years for the prevention of invasive pneumococcal disease (but not pneumonia or otitis media) caused by the serotypes contained in the vaccine.
How are these vaccines administered?
- PPSV23 - given as an injection either in the muscle or the fatty tissue of the arm or leg.
- PCV7 - as an injection into the muscle of the antero-lateral thigh or deltoid.
- PCV10 - given as an injection into the muscle of the antero-lateral thigh or deltoid.
Who is PPSV23 for?
- All adults 65 years of age, or older.
- Everyone aged 2 years or more who has a chronic health problem, such as cardiovascular disease, sickle cell anemia, lung disease, diabetes, cerebrospinal fluid leakage, or cirrhosis.
- Any patient who has a cochlear implant, or is about to have one.
- Everyone aged 2 years or more whose immune system is weak. Examples include patients with Hodgkin's disease, kidney failure, nephrotic syndrome, leukemia, lymphoma, multiple myeloma, HIV/AIDS, damaged spleen or no spleen, or patients who have received an organ transplant.
- Everyone aged 2 years or more who is receiving medication or treatment that weakens their immune system, such as radiotherapy, chemotherapy, and long-term steroids.
- Patients with asthma aged 19 to 64 years.
- Smokers aged 19 to 64 years.
- In the USA, in special situations, public health authorities may recommend PPSV23 after PCV7 for Alaska Native or American Native Indian children aged between 24 to 59 months if they are living in areas where the risk of invasive pneumococcal disease is increased.
- In the USA, in special situations, public health authorities may recommend PPSV23 for Alaska Native or American Native Indian children aged from 50 to 64 years if they are living in areas where the risk of invasive pneumococcal disease is increased.
Who is PCV7 for?
- Every infant should receive a four-dose series of the vaccine at ages 2, 4, 6 and 12-15 months. In the context of a national immunization programme, three doses are deemed sufficient. Other schedules have been recommended by authorities.
- A catch-up vaccination should be given to children younger than 5 years of age who did not get the PCV7 vaccine on schedule.
- The older children are the fewer shots they will need. A healthy child aged 24-59 months who has never received a vaccine needs just one PCV7 shot.
People aged 5 years or older are not routinely given PCV7 shots.
Who is PCV10 for?
- Every infant should receive a four-dose series of the vaccine.
Who gets both PCV7 and PPSV23?
Children at high risk of invasive pneumococcal disease should be given PCV7 and then PPSV23 at age 2 years or older. Healthy children are not routinely given PPSV23.
Side effects of PPSV23
Health authorities say the vaccine is safe. Between 30% and 50% of patients have mild pain or redness at the injection site. Fewer than 1% of all patients develop a fever, muscle aches, or more severe local reactions. Serious allergic reactions are extremely rare.
Side effects of PCV7
Health authorities say the vaccine is safe. Between 10% and 20% of children develop redness, tenderness, or swelling at the injection site. Approximately 11% get a mild fever.
How effective is PPSV23?
"There is evidence for efficacy against invasive disease but less evidence for efficacy against pneumonia. However, as people aged over 65 and individuals with significant underlying illnesses have a higher risk of developing severe pnuemococcal disease, vaccination with PPSV23 is still recommended."1, 2, 3, 4
How effective is PCV7?
A large clinical study showed that PCV7 is 97% effective in preventing invasive disease caused by the pneumococci contained in the vaccine.
Children with chronic diseases, such as HIV infection and sickle cell disease appear to respond well to PCV7.
Who should not be given the vaccine?
- Anybody who had a severe allergic reaction to either PPSV23 or PCV7 from one dose should not be given subsequent doses. Severe allergic reactions are extremely rare.
- People who are severely or moderately ill should be given the vaccine when their condition improves.
Can either vaccine cause pneumococcal disease?
No. In both vaccines - PPSV23 and PCV7 - only a portion of the microbe is included. It is impossible for them to cause pneumococcal disease. They are inactivated vaccines.
1Jackson et al; Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults. N Engl J Med 2003; 348:1747-55.
2Jackson L, Janoff E; Pneumococcal Vaccination of Elderly Adults: New Paradigms for Protection. Clinical Infectious Diseases 2008; 47:1328–38
3Trotter et al; Pneumococcal polysaccharide vaccine effectiveness: study quality must not be ignored. Lancet 2008; 8:664
4Use of pneumococcal polysaccharide vaccine for subjects over 65 years of age during an inter-pandemic period Stockholm, January 2007 – ECDC Technical Report