Pneumococcal vaccine

Recommended for all immunocompromised persons older than 65 years, persons age 2 to 64 years with chronic illnesses, congestive heart failure, COPD, diabetes, alcoholism, chronic liver disease, functional or anatomic asplenia.

In 2012 there were an estimated 31,600 cases of pneumococcal infections and 3380 deaths in the US.

The highest rates of infection or among children and adults age 65 or older.

Heptavalent pneumococcal conjugate vaccine (PCV7) against serotypes 4, 6b, 9v, 18c, 19f, and 23F.

Does not protect children younger than 2 years.

Heptavalent conjugate vaccine is recommended for all children 6 weeks to 23 months of age and selected children 24-59 months old at risk for pneumococcal disease.

Heptavalent vaccine highly effective in children against invasive infections, moderately effective against pneumonia and somewhat useful against otitis media.

Heptavalent conjugate vaccine is not recommended for adults for which the 23-valent Pneumococcal vaccine is indicated.

Newly available PCV13 covers the above 7 Streptoccus serotypes plus 1,3,5,6A, 7F and 19F.

PCV13 contains capsular polysaccharide antigens from 13 strains of S pneumonia including the 6A strain, not included in the PPSV23 vaccine, conjugated to inactivated diphtheria-tetanus toxoid.

The conjugated vaccine formulation elicits a more robust T-cell immune response from PPSV23 which is processed through a T-cellindependent pathway.

Patients that have received this vaccine and subsequently experienced community acquired pneumonia have better outcomes than patients with community acquired pneumonia without the vaccine.

23-valent pneumococcal columns that provide vaccine (PPSV23) is recommended for prevention of invasive pneumococcal disease in adults since 1983.

Recommended one dose of Prevnar (PCV13) followed by PPSV23 dose 8 weeks later and a second dose 5 years later.

PPSV23 Is associated with prevention of invasive pneumococcal disease but no evidence exists that it is associated with reduced rates of all cause pneumonia or all cause mortality.

The polysaccharide vaccine most commonly used today consists of purified polysaccharides from 23 serotypes (1, 2, 3, 4, 5, 6b, 7F, 8,9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F).

Immunity is induced primarily through stimulation of B-cells which release IgM without the assistance of T cells.

Pneumococcal polysacchardie vaccine 23 reccomended for children aged <5 years and for all persons aged 2-64 years with high risk processes and all persons 65 years or older.

All smokers over the age of 19 should be vaccinated, as should all persons with type 1 diabetes mellitus over the age 2.

Data do not support the use of Pneumovax in smokers under age 19.

Adults who received a single dose after age 65 do not need any further doses.


The PCV13 vaccine is no longer recommended for routine vaccination in immunocompetent adults.

The PCV13 vaccine is recommended for: 

Immunocompromised adults aged 19 years or older

Adults with immunocompromising conditions, cerebrospinal fluid leak, or cochlear implant.

Immunocompetent adults aged 65 years or older


Adults who got a dose before turning 65 should get a second dose once 5 years have lapsed following the first dose.

Immune response is less robust than the response provoked by conjugated vaccines.

The vaccine is ineffective in children less than two years old, presumably due to their less mature immune systems.

Non-responders are also common amongst older adults.

Immunization is not lifelong, so individuals must be re-vaccinated every 5–6 years.

No mucosal immunity is provoked, and the vaccine does not affect carrier rates, promote herd immunity, or protect from upper or lower respiratory tract infections.

The conjugated vaccine consists of capsular polysaccharides covalently bound to the diphtheria toxoid CRM197.

Capsular polysaccharides bound to the diphtheria toxoid CRM197 provokes an immune response by recruiting type 2 helper T cells, which allow for immunoglobulin type switching and production of memory B cells.

Vaccination results in eventual establishment of lifelong immunity after several exposures.

Conjugated vaccines provide protection against a subset of the serotypes covered by the polysaccharide vaccines.

Protection is good against deep pneumococcal infections.

Pneumococcal polysaccharide vaccine provides at least 85% protection in those under 55 years of age for five years or longer.

Immunization for those at highest risk of infection, including those 65 years or older.

The standard 23-valent vaccines are ineffective for children under two years old.

The current guidelines call for administration of the immunization between ages 2 and 65 when indicated, or at age 65.

Adult 65 years or older should receive only 23-valent pneumococcal polysaccharide vaccine-PPSV 23-with few exceptions.

Widespread childhood vaccination with PCV 13 and its predecessor the seven valent pneumococcal conjugate vaccine have led to sharp declines in pneumococcal disease among unvaccinated children and adults and this is now removed the recommendation for a routine use of PCV 13 followed by a PPSV 23 in this population.

Immunization before age 60, guidelines call for a one-time revaccination.

Revaccination at periodic intervals is indicated for conditions such as asplenia or nephrotic syndrome.

Pneumovax 23 has a reported 76% to 92% protective efficacy (pneumococcal types 1, 2, 3, 4, 5, 6B**, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F are included, and these are the 23 most prevalent or invasive pneumococcal types of Streptococcus pneumoniae.

Childhood vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7) has decreased both invasive pneumococcal disease and non pneumococcal pneumonia in children through direct and indirect herd immunity vaccine effects and reduces adult pneumococcal disease through indirect effects.

PCV7 has reduced incidence of disease in vaccinated young children and non-vaccinated groups due to herd immunity

Adults age 19 years or older with an in immunocompromised condition, CSF leak, cochlear implant should receive both vaccines.




Updated Pneumococcal Vaccine Recommendations for Older Adults




CDC used to recommend routine use of two pneumococcal vaccines for all adults aged 65 years or older.




The  13-valent pneumococcal conjugate vaccine, PCV13,  is sold under the trade name of Prevnar 13.




The second vaccine is the 23-valent pneumococcal polysaccharide vaccine, PPSV23, sold under the trade name of Pneumovax 23.




PCV13 is now recommended on the basis of shared clinical decision-making rather than routinely for all adults aged 65 years or older who have never received PCV13.




This change applies to older adults who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant.




PCV13 is still routinely recommended for older adults with those conditions who have never previously received a dose.




CDC recommends PPSV23 routinely for all adults aged 65 years or older.




The number of pneumococcal stereotypes PCV13 vaccine can prevent has declined to historically low levels among older adults.




PCV13 has been given to children since 2010, which has reduced  carriage of pneumococci.




As a result, transmission of pneumococci from vaccinated children to unvaccinated individuals, including adults, has decreased.




CDC has noted giving the vaccine to older adults had only a minimal impact on adult disease at the population level.




In most communities, the risk for exposure to the 13 pneumococcal strains covered by the vaccine is low: some groups are potentially at increased risk for exposure and thus might get more benefit from PCV13 vaccinations and include people living in nursing homes or other long-term care facilities.


Individuals who have a chronic medical conditions:  chronic heart, lung, or liver disease; diabetes, alcoholism, and smokers are at increased risk for pneumococcal disease if they are exposed.


PCV13 is a safe and effective vaccine for older adults, but the risk for PCV13-type disease among adults aged ≥ 65 years is much lower than it was before the pediatric program was implemented.


Adults aged ≥ 65 years are potentially at increased risk for exposure to PCV13 serotypes and might attain higher-than-average benefit from PCV13 vaccination.


Candidates for PCV13 are persons residing in nursing homes or other long-term care facilities


Persons residing in settings with low pediatric PCV13 uptake


Persons traveling to settings with no pediatric PCV13 program.


Incidence of PCV13-type invasive pneumococcal disease increases with  age and is higher among persons with chronic medical conditions like chronic heart, lung, or liver disease; diabetes; or alcoholism; and those who smoke cigarettes.


If a patient and a clinician decide that PCV13 is right for the patient, then it should be given first.

PPSV23 should be administered at least 1 year later so that the patient gets maximum benefit from both vaccines.

PCV 20(Prevnar)  contains antigens from 20 serotypes of pneumococcus.

Vaxneuvance contains 15 serotype antigens.






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