Q: What do I need to know about pneumococcal vaccines?
A: The first pneumococcal vaccine—PCV7—was licensed in 1977. The vaccines currently in use for children and adults to protect against pneumococcal infections are pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23).
PCV13 provides children younger than age 2 with immunity against 80% of the most common strains of pneumococcal disease. The 2014 PPSV23 protects patients age 2 and older against 23 different types of pneumococcal bacteria, including serotype 19a, which is responsible for approximately 46% of all pneumococcal infections in children and adults. Of the 46% of patients who have the serotype 19a strain, 30% have multidrug-resistant pneumococcal infections. Most patients develop immunity within 2 to 3 weeks after they're vaccinated with PCV13 or PPSV23.
The CDC recommends that PCV13 be administered in four doses to infants at the following ages:
- first dose at 2 months
- second dose at 4 months
- third dose at 6 months
- fourth dose at 12 to 15 months.
PCV13 should also be administered to all children younger than age 5 and adults with certain risk factors, such as cochlear implants, cerebrospinal fluid (CSF) leaks, sickle cell disease, asplenia, and immunocompromised patients. All adults older than age 65, those over age 19 at high risk for acquiring pneumococcal disease, and children age 2 or older who are at high risk should also receive PPSV23.
Patients who should receive PPSV23 each year include:
- all adults older than age 65
- adults ages 19 to 64 who smoke or have asthma
- patients ages 2 to 54 who have lung disease, cirrhosis, heart disease, diabetes, alcoholism, sickle cell anemia, CSF leakage, cochlear implants, renal failure, Hodgkin disease, leukemia, lymphoma, recent joint replacements, multiple myeloma, and HIV/AIDS
- organ transplant recipients
- patients taking chemotherapy or steroid medications
- oncology patients receiving radiation therapy.
Children should be evaluated on a case-by-case basis by the healthcare team. Factors that may be considered include the child's current clinical health and any chronic or immunosuppressive diseases he or she may have to decide if the potential risk warrants vaccination.
If a patient received his or her initial vaccination before age 65, he or she should receive an additional PPSV23 vaccination yearly after turning age 65 to maintain the same immunity. Additionally, patients ages 2 to 64 who have any of the following conditions should be individually considered for yearly PPSV23:
- damaged spleen or splenectomy
- sickle cell disease
- cancer, leukemia, lymphoma, or multiple myeloma
- nephrotic syndrome
- organ or bone marrow transplant
- chemotherapy or steroids that are known to lower the body's immunity.
Since the initial recommendation, invasive pneumococcal disease in children has dropped by nearly 80% in the United States over the last 3 decades. PCV13 has very few adverse reactions. According to the CDC, in approximately 60,000 doses of PCV13 administered, there have been no reported moderate or severe reactions. However, approximately 20% of patients who receive PCV13 will experience mild adverse reactions, such as injection site reactions (localized pain, tenderness, and edema at the injection site), fever, decreased appetite, irritability, and increased or decreased sleep.
Adverse reactions to PPSV23 are usually mild, such as localized pain or erythema at the injection site that typically resolves within 48 hours. According to the National Institutes of Health, less than 1% of the population will experience a mild fever. Observe for signs and symptoms of an allergic reaction, such as dyspnea, increased work of breathing, hoarseness or wheezing, hives, paleness, weakness, increased heart rate, and dizziness. If these symptoms occur, have a team member stay with the patient and consult with the physician immediately; monitor the patient's respiratory rate for the potential need for rescue breathing.
Provide information both verbally and in print to your patients on the benefits and risks associated with vaccination so that the patient, caregiver, or legal guardian can make a well-informed decision.