Pneumococcal vaccine

  • Currently two different vaccines are used in the UK, one in the routine childhood immunisation schedule for all babies and the other for everyone over 65. 
  • These vaccines are also available to people with particular health conditions that increase their risk from pneumococcal infection. 
  • The single most important thing you can do to prevent pneumococcal meningitis is to make sure your children are up to date with their routine immunisations, and to have the immunisations you are eligible for.

Pneumococcal ‘conjugate’ vaccine (PCV)

The current vaccine in the childhood immunisation schedule, Prevenar13®(PCV13) can protect against severe infection caused by thirteen of the most common strains of pneumococcal bacteria. 

This vaccine:

  • is routinely offered to all babies at 2, 4 and 12-13 months of age, within the routine childhood immunisation programme,
  • is similar to the successful Hib and MenC vaccines, which are also conjugate vaccines,
  • provides direct protection to those who are vaccinated. However, because the vaccine also reduces the number of people who are carrying and potentially transmitting the bacteria, people who are not vaccinated also benefit from indirect protection. This is called ‘herd’ immunity. 

PCV13 was introduced in spring 2010 and directly replaced PCV7,which only provided protection against seven strains of pneumococcal bacteria. The change was made to provide broader coverage for children by protecting against six additional strains of bacteria.

Is this vaccine safe for my child?

Yes. The widespread use of PCV7 in over 100 countries, with over 300 million doses distributed worldwide, established a solid safety record.Clinical trial data from studies involving more than 7000 children show that PCV13 has a similar safety profile to PCV7.

What if my child has already received one or two doses of PCV7?

Children who have already received one or two doses of PCV7 can complete their vaccination course with PCV13 with no change to the routine vaccination schedule.

Did PCV7 vaccine reduce cases of pneumococcal meningitis after it was introduced in 2006?

PCV7 was very successful at preventing the seven strains of pneumococcal infection it covers. In the first two and a half yearsafter the introduction of PCV7, it is been estimated that 959 cases of serious illness and 53 deaths due to invasive pneumococcal disease were prevented2.

Meanwhile, as disease caused by the seven most common strains decreased, cases caused by other strains of pneumococcal bacteria had been increasing3. Therefore, the vaccine was upgraded to provide broader protection.

There are over 90 strains of pneumococcal bacteria, but most strainsrarely cause disease. PCV13 covers the strains that account for approximately 74% of all severe pneumococcal disease in young children in England and Wales1.

Severe pneumococcal disease in children aged under 5 caused by strains in Prevenar and Prevenar13

 

Pneumococcal ‘polysaccharide’ vaccine (PPV)4

This vaccine provides a level of short-term protection against serious pneumococcal disease caused by the top 23 disease-causing types of pneumococcal bacteria (see box opposite). This vaccine is offered toadults over the age of 65 and children over the age of 2 who have health conditions which put them at increased risk from pneumococcal infection.

What health conditions increase the risk from pneumococcal infection?

Health conditions which increase the risk of infection include4:

  • having no spleen, due to injury or disease, or a spleen that does not work properly as in sickle cell disorder, and coeliac disease;
  • other immunodeficiency, whether inherited or acquired (e.g. HIV);
  • immunosuppression as with cancer therapy or organ transplant;
  • chronic disease of the heart, kidney or liver;
  • chronic respiratory diseases, including, for example, asthma requiring repeated use of systemic steroids, chronic obstructive pulmonary disease;
  • diabetes requiring insulin;
  • people with or about to have cochlear implantation or other conditions where leakage of cerebrospinal fluid can occur (but vaccination must not delay cochlear implantation).

What protection is offered to people with 'at risk' health conditions?

People with at risk health conditions should be offered vaccination with PCV, PPV or both depending on their age and the condition they have.

In general the following applies to people with “at risk” health conditions*:

  • Babies should be immunised according to the routine schedule followed by one dose of PPV after their second birthday,
  • Children under 5 years of age, who haven’t previously been vaccinated should be offered PCV and then PPV after their second birthday,
  • Children over 5 years of age and adults should be offered PPV if they haven’t already received this.
*People with an absent or damaged spleen, who are HIV positive, receive bone marrow transplants or have chronic renal diseaseshould seek specialist advice as recommendations in these cases can differ.

Children under 2 years of age with at risk conditions and who have already had the full course of PCV7 are eligible for a PCV13 vaccination.

Children who get severe pneumococcal disease

Any child under age 5 years who gets pneumococcal meningitis or other severe pneumococcal disease will be followed up by their GP or paediatrician, to check whether they have an ‘at-risk’ health condition5. These children should be offered PCV even if they have already had it. They may also be offered PPV.

ALL children who are under the age of 2 and have missed immunisations are entitled to receive PCV and are entitled to receive other routine immunisations up to age 10.

IMPORTANT: Vaccines cannot protect against all forms of meningitis

It is important to remember that although vaccine scan provide excellent protection, there are still some types of meningitis and septicaemia for which there are no vaccines. It is important to be aware of the symptoms of these diseases and to seek medical help immediately if you suspect that someone has meningitis or septicaemia.

References


  1. Kaye P, Malkani E, Martin S, Slack M, Trotter C, Jit M, George R & Miller E. Invasive pneumococcal disease (IPD) in England & Wales after 7-valent conjugate vaccine (PCV7); potential impact of 10 and 13-valent vaccines.
  2. Report of the Director of Immunisation: April 2009.(Accessed 17 Feb 2010).
  3. Pichon B, Beasley L, Slack M, Efstratiou A, Miller E. and George R. Effect of the introduction of the pneumococcal conjugate vaccine in the UK childhood immunisation scheme on the genetic structure of paediatric invasive pneumococci.  (Accessed 17 Feb 2010)
  4. Department of Health. Immunisation against infectious diseases. Chapter 25: Pneumococcal. August 2006. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4137924.pdf (accessed 25 Feb 2010).
  5. Health Protection Agency. Clinical Management Protocol version 3: January 2007 (accessed 17 March 2008).

Pneumococcal vaccine in Ireland

There are currently two vaccines that protect against pneumococcal disease; a 23-type 'polysaccharide' vaccine for and a newer 7-type 'conjugate' vaccine.

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. This vaccine covers the seven types that cause over 80% of serious pneumococcal disease in Irish and UK children aged 6 months to 2 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 also offered routinely in the UK, Australia, Canada, Austria, Italy, Spain and Norway.

This vaccine was introduced into the Irish childhood vaccination programme on 1 September 2008.

A newer 13-type vaccine will replace the 7-type later on this year.