Pneumococcal vaccination in the UK
Vaccines against pneumococcal disease
There are currently two vaccines that protect against pneumococcal disease1 - a 23-type 'polysaccharide' vaccine for people over the age of two and a newer 7-type 'conjugate' vaccine for children aged two months to five years.
23-type 'polysaccharide' vaccine
This vaccine can protect most adults for five years or more against the top 23 disease-causing types of pneumococcal infection. However, it does not work in children under two years old and is less effective in people with immune deficiencies and the under-fives.
7-type 'conjugate' vaccine
The newer 7-type conjugate vaccine is similar to the successful Hib and Men C vaccines, which provide stronger, more long-term protection than the plain polysaccharide vaccines, even in babies. The vaccine covers the seven types that cause over 80% of serious pneumococcal disease in UK children aged six months to two years, and about 75% in the under fives in Europe generally.
The routine use of this vaccine in America since June 2000 has established a good safety record and shown that it is effective. It is now offered routinely in Canada and Austria.
This vaccine was introduced into the UK childhood vaccination programme on 4 September 2006.
The current UK recommendation for pneumococcal vaccine2 is that people (aged two months or over) with the following clinical risk factors should get pneumococcal vaccination appropriate to their age:
- having no spleen, due to injury or disease, or a spleen that does not work properly as in sickle cell disorder, thalassaemia, and coeliac disease;
- other immunodeficiency, whether inherited or acquired (e.g. HIV);
- immunosuppression as with cancer therapy or organ transplant, including people taking high dose steroids for more than a month;
- chronic disease of the heart, kidney or liver (including nephrotic syndrome and alcoholic cirrhosis);
- chronic respiratory diseases, including, for example, asthma requiring repeated use of systemic steroids, chronic obstructive pulmonary disease, cystic fibrosis and children with respiratory conditions caused by aspiration or with a risk of aspiration
- diabetes requiring insulin;
- people with or about to have cochlear implantation or other conditions where leakage of cerebrospinal fluid can occur, including people with CSF shunts
- children under age 5 who have previously had severe pneumococcal disease (e.g. pneumococcal meningitis or pneumococcal septicaemia).
Patients about to have splenectomy, cancer therapy, organ transplant, should be vaccinated beforehand if possible: ideally 4 to 6 weeks, but at least 2 weeks before surgery or treatment. Patients about to have cochlear implantation, or an operation to install a CSF shunt should also be vaccinated at least 2 weeks beforehand if possible. Immunisation should not delay cochlear implantation2.
Children who receive the 7-type conjugate vaccine should be offered the 23-type polysaccharide vaccine after their second birthday and at least 2 months after their final dose of 7-type conjugate vaccine. Children under 5 who have already received the 23-type polysaccharide vaccine should be offered the 7-type conjugate vaccine starting at least 2 months after the polysaccharide2.
In addition to the recommendation for people with clinical risk factors, the 23-type vaccine is also recommended for all those aged 65 years and over2.
References
- Department of Health. Immunisation against infectious diseases. Replacement chapter 25: Pneumococcal. Sept 2004.
- Donaldson L. The pneumococcal immunisation programme for older people and risk groups. Department of Health PL/CMO/2005/1 March 2005.
Page last updated 07.07.08