Pneumococcal Vaccination (Pneumonia Vaccine)

There are two types of vaccine: PPSV23 (Pneumovax), a pneumococcal polysaccharide vaccine against 23 types of bacteria, and PCV13 (Prevnar 13) - valent conjugate vaccine. Source: Getty Images

Pneumococcal vaccination is a method of preventing a specific type of lung infection (pneumonia) that is caused by the pneumococcus (Streptococcus pneumoniae) bacterium. There are more than 80 different types of pneumococcus bacteria -- 23 of them covered by the vaccine. The vaccine is injected into the body to stimulate the normal immune system to produce antibodies that are directed against pneumococcus bacteria.

This method of stimulating the normal immune system to be directed against a specific microbe is called immunization. Pneumococcal vaccination is also referred to as pneumococcal immunization.

Pneumococcal vaccination does not protect against pneumonia caused by microbes other than pneumococcus bacteria, nor does it protect against pneumococcal bacterial strains not included in the vaccine. It is reassuring to note that of the 80 different serotypes, the vast majority of infections are caused by the 23 serotypes contained in the vaccine.

In children, especially under 2 years of age, a special conjugated vaccine has been developed to stimulate less-developed immune systems. Originally only covering seven serotypes, the newer vaccine released in 2010 now covers 13 serotypes of the pneumococcus (Prevnar 13) - valent conjugate vaccine.

Pneumococcal vaccination should be considered by people in the following groups:

• Adults 65 years of age and older
• People > 2 years of age with chronic heart or lung disorders, including congestive heart failure, diabetes mellitus, chronic liver disease, alcoholism, spinal fluid leaks, cardiomyopathy, chronic bronchitis, chronic obstructive pulmonary disease (COPD), or emphysema
• People > 2 years of age with spleen dysfunction (such as sickle cell disease) or lack of spleen function (asplenia), blood malignancy (leukemias), multiple myeloma, kidney failure, organ transplantation, or immunosuppressive conditions, including HIV infection
• Alaskan natives and certain American Indian populations
• If elective surgical removal of the spleen (splenectomy) or immunosuppressive therapy is planned, the vaccine is given two weeks prior to the procedure, if possible.

The pneumococcal vaccine should not be received by people with a prior history of hypersensitivity reactions to the vaccine.

The safety of the pneumococcus vaccine for pregnant women has not yet been studied. There is no evidence that the vaccine is harmful to either the mother or the fetus, but pregnant women should consult with their doctor before being vaccinated. Women who are at high risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.

Pneumococcal vaccine uncommonly causes side effects. Reported side effects include

• soreness and/or redness at the site of the injection,
• fever,
• rash, and
• allergic reactions.

The adverse effects are similar and minimal, main soreness at the injection site, fatigue, headache, chills, and diffuse achiness.

The pneumococcal vaccine is given as a single injection in adults. The vaccine is injected as a liquid solution of 0.5 mL into the muscle (intramuscular or IM), typically deltoid muscle, or under the skin (subcutaneous or SC). The area injected is typically disinfected by rubbing alcohol onto the skin prior to the injection.

• The conjugated Prevnar 13 vaccine is given as a series of four injections in children.
• People vaccinated prior to age 65 should be vaccinated at age 65 if five or more years have passed since the first dose.
• For people with a lack of spleen function (such as in sickle cell disease or after spleen removal), transplant patients, patients with chronic kidney disease, immunosuppressed or immunodeficient people, and others at the highest risk of fatal infection, a second dose should be given at least five years after the first dose.

When indicated, vaccines should be administered to patients with unknown vaccination status. All residents of nursing homes and other long-term care facilities should have their vaccination status assessed and documented.

How long must a person wait to receive other vaccinations?

Inactivated influenza vaccine and tetanus vaccines may be given at the same time as or at any time before or after a dose of the pneumococcus vaccine. There are no requirements to wait between the doses of these or any other inactivated vaccines.

Recommended pneumococcal vaccination schedule

In July 2000, the American Academy of Pediatrics (AAP) and the CDC jointly recommended childhood pneumococcal immunization, since pneumococcal infections are the most common invasive bacterial infections in children in the United States.

"The pneumococcal conjugate vaccine, PCV13 or Prevnar 13, is currently recommended for all children younger than 5 years of age, all adults 65 years or older, and persons 6 through 64 years of age with certain medical conditions," according to the 2014 AAP/CDC guidelines.

• "Pneumovax is a 23-valent pneumococcal polysaccharide vaccine (PPSV23) that is currently recommended for use in all adults 65 years of age or older and for persons who are 2 years and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immunocompromising conditions).
• PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma."

• Patients who are healthy and have never received the pneumococcal pneumonia vaccine (PPSV23), if equal to or older than 65 years of age, should receive the PCV13 first and then within six months to a one-year receive the PPSV23.
• Those who have already received the PPSV23 should get the PCV13 about one year later.
• If the person received the PPSV23 over five years earlier, they essentially should be treated as if they never received the vaccine, getting the PCV13 injection, followed about six to 13 months later by the PPSV23.
• In general, there seems to be a better immune response to the overlapping 13 strains of pneumococcus if the PCV13 is received first.
• The adverse effects are similar and minimal, with main soreness at the injection site, fatigue, headache, chills, and diffuse achiness.