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Pneumococcal Vaccine

By

Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Last review/revision Oct 2022
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Pneumococcal disease Pneumococcal Infections Streptococcus pneumoniae (pneumococci) are gram-positive, alpha-hemolytic, aerobic, encapsulated diplococci. In the US, pneumococcal infection is a major cause of otitis media, pneumonia... read more (eg, otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more Otitis Media (Acute) , pneumonia Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. Initial diagnosis is usually based on chest x-ray and clinical findings. Causes, symptoms, treatment, preventive measures, and... read more , sepsis Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more , meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Findings typically include headache, fever, and nuchal rigidity. Diagnosis is by... read more ) is caused by some of the > 90 serotypes of Streptococcus pneumoniae (pneumococci). Vaccines are directed against many of the serotypes that cause disease. Certain medical conditions (eg, chronic disorders, immunocompromising conditions, cerebrospinal fluid leaks, cochlear implants) increase the risk of pneumococcal disease.

For more information, see Pneumococcal Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Pneumococcal Vaccination. A summary of changes to the 2022 adult immunization schedule is available here.

Preparations of Pneumococcal Vaccine

There are 2 types of pneumococcal vaccines: conjugate and polysaccharide.

The 13-valent pneumococcal conjugate vaccine (PCV13) contains 13 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 9V, 14, 18C, 19A, 19F, 23F).

The 15-valent pneumococcal conjugate vaccine (PCV15) contains 15 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F).

The 20-valent pneumococcal conjugate vaccine (PCV20) contains 20 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F).

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) contains antigens from the 23 most virulent of the 83 subtypes of S. pneumoniae (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F).

Unlike the older PPSV23, PCV13 can stimulate antibody responses in infants. It also seems to confer greater protection against invasive pneumococcal disorders than PPSV23. PPSV23 reduces bacteremia by 56 to 81% in adults overall but is less effective in debilitated older people. It reduces pneumonia incidence.

Indications for Pneumococcal Vaccine

Adults age 65 years or older who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown should receive either

  • 1 dose of PCV20 or

  • 1 dose of PCV15 followed by a dose of PPSV23

Adults 19 to 64 years who have certain medical conditions or other risk factors (see below Indications ) who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown should receive either

  • 1 dose of PCV20 OR

  • 1 dose of PCV15 followed by a dose of PPSV23

For both age groups, the dose of PPSV23 should follow the dose of PCV15 by at least 1 year. A minimum interval of 8 weeks between PCV15 and PPSV23 can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leak.

Medical conditions and risk factors include the following:

  • Alcohol use disorder

  • Chronic heart, lung, or liver disease

  • Chronic renal failure or nephrotic syndrome

  • Cigarette smoking

  • Cochlear implant

  • Congenital or acquired asplenia

  • CSF leak

  • Diabetes mellitus

  • Generalized cancer

  • HIV

  • Hodgkin disease

  • Immunodeficiency or immunosuppression

  • Leukemia, lymphoma, or multiple myeloma

  • Solid organ transplants

  • Sickle cell disease or other hemoglobinopathies

Children up to 18 years of age should receive the PCV13 pneumococcal vaccine (see table ).

Contraindications and Precautions of Pneumococcal Vaccine

The main contraindication for PCV13 is

The main contraindication for PCV15 is

  • A severe allergic reaction (eg, anaphylaxis) to any component of PCV15 or to diphtheria toxoid

The main contraindication for PCV20 is

The main contraindication for PPSV23 is

  • A severe allergic reaction after a previous dose of the vaccine or to a vaccine component

Precautions with either type of vaccine include

  • Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)

For children with functional or anatomic asplenia, meningococcal conjugate vaccine (MenACWY Meningococcal Vaccine The meningococcal serogroups that most often cause meningococcal disease in the US are serogroups B, C, and Y. Serogroups A and W cause disease outside the US. Current vaccines are directed... read more ) and PCV13 should not be given during the same visit but should be separated by ≥ 4 weeks.

Administration of Pneumococcal Vaccine

The usual dose of each vaccine is

  • 0.5 mL IM for PCV20

  • 0.5 mL IM for PCV13

  • 0.5 mL IM for PCV15

  • 0.5 mL IM or subcutaneous for PCSV23

People with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis.

Adults aged 19 to 64 years at highest risk of pneumococcal disease (eg, with functional or anatomic asplenia, chronic kidney disease, or another immunocompromising condition, including cancer and use of corticosteroids) should be given a second dose of PPSV23 5 years after the first PPSV23 dose.

All people should be vaccinated with PPSV23 at age 65. If people were given 1 or 2 doses of PPSV23 before age 65 for any indication and ≥ 5 years have elapsed since their previous PPSV23 dose, they should be given another dose of the vaccine at age 65 or later. The second dose is given 5 years after the first (eg, at age 69 if the previous dose was given at age 64). Those who are given PPSV23 at or after age 65 should be given only 1 dose.

When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be ≥ 2 weeks. People should be not be vaccinated during chemotherapy or radiation therapy.

Adverse Effects of Pneumococcal Vaccine

Adverse effects are usually mild and include fever, irritability, drowsiness, anorexia, vomiting, and local pain and erythema.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

Drug Name Select Trade
Pneumovax 23, Pnu-Imune-23 , Prevnar, Prevnar 13 , Prevnar 20, VAXNEUVANCE
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