Questions & Answers

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When did pneumococcal vaccine become available?
There are two types of pneumococcal vaccine, pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine.

The first pneumococcal polysaccharide vaccine was licensed in the United States in 1977. In 1983, an improved pneumococcal polysaccharide vaccine was licensed, containing purified protein from 23 types of pneumococcal bacteria (the old formulation contained 14 types). This pneumococcal polysaccharide vaccine is commonly known as PPSV23. The PPSV23 vaccine is licensed for use in adults and persons with certain risk factors who are age two years and older.

The pneumococcal conjugate vaccine was licensed in early 2000. It is recommended for use in preventing pneumococcal disease in infants and young children (from age six weeks to the 5th birthday). It is commonly known as PCV7.

What kind of vaccines are they?
Both pneumococcal vaccines are made from inactivated (killed) bacteria. The pneumococcal polysaccharide vaccine (PPSV23) contains long chains of polysaccharide (sugar) molecules that make up the surface capsule of the bacteria. The 23 types of pneumococci that are included cause 88% of invasive pneumococcal disease.

The pneumococcal conjugate vaccine (PCV7) includes purified capsular polysaccharide of seven types of the bacteria "conjugated" (or joined) to a harmless variety of diphtheria toxin. The seven types of purified bacteria included account for 86% of bacteremia, 83% of meningitis, and 65% of acute otitis media (ear infection) among children younger than age six years in the United States.

How is this vaccine given?
The polysaccharide vaccine (PPSV23) can be given as a shot in either the muscle or the fatty tissue of the arm or leg. The conjugate vaccine (PCV7) is given as a shot in the muscle.

Who should get the pneumococcal polysaccharide vaccine (PPSV23)?

• All adults age 65 years or older
• Anyone age two years or older who has a long-term health problem such as cardiovascular disease, sickle cell anemia, alcoholism, lung disease, diabetes, cirrhosis, or leaks of cerebrospinal fluid
• Anyone who has or is getting a cochlear implant
• Anyone age two years or older who has a disease or condition that lowers the body's resistance to infection, such as Hodgkin's disease, kidney failure, nephrotic syndrome, lymphoma, leukemia, multiple myeloma, HIV infection or AIDS, damaged spleen or no spleen, or organ transplant
• Anyone age two years or older who is taking any drug or treatment that lowers the body's resistance to infection, such as long-term steroids, certain cancer drugs, or radiation therapy
• Adults ages 19-64 who have asthma
• Adults ages 19-64 who smoke cigarettes
• In special situations, public health authorities may recommend the use of PPSV23 after PCV7 for Alaska Native or American Indian children ages 24 through 59 months who are living in areas in which risk of invasive pneumococcal disease is increased.
• In special situations, public health authorities may recommend PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.

Who should get the pneumococcal conjugate vaccine (PCV7)?
All infants beginning at two months of age should receive a four-dose series of vaccine; catch-up vaccination is recommended for children younger than age 5 years who did not receive PCV7 vaccine on schedule.

What is the schedule for the routine doses of PCV7 for children?
All infants and toddlers should get four doses of PCV7 vaccine, usually given at ages two, four, six, and 12-15 months.

What if my three-year-old child never got his PCV7 shots?
The number of doses a child needs to complete the series depends on his or her current age. Older children need fewer doses. For example, a healthy unvaccinated child age 24-59 months needs a single dose of PCV7. Your healthcare provider can tell you how many doses are needed to complete the series at a certain age. PCV7 is not routinely recommended for individuals who are age five years or older.

Do some children need to get both PCV7 and PPSV23?
Yes, children at high risk of invasive pneumococcal disease should receive PCV7 and then also receive PPSV23 when age two years or older. PPSV23 is not given routinely to healthy children.

If influenza is recommended for healthcare workers to protect high-risk patients from getting influenza, why isn't pneumococcal vaccine also recommended?
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than just having the bacteria in one's nose or throat.

My elderly neighbor got a second pneumococcal shot. I thought just one was required.

Revaccination is not done routinely, but a single revaccination dose is recommended for groups of people at highest risk of serious infection. No one should receive more than two doses of PPSV23.

For example, persons who received a first dose when they were younger than age 65 years should receive a second dose at age 65 years if at least five years have elapsed since the previous dose. Likewise, persons age two years or older who are at high risk for pneumococcal disease due to certain long-term health problems, in particular immunosuppression, HIV infection, and not having a functional spleen (or having no spleen) should get a second dose five or more years after the first dose.

Anyone interested in the full list of recommendations for revaccination with PPSV23 can find a chart at www.immunize.org/catg.d/p2015.pdf

Who recommends pneumococcal vaccines?
The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have all recommended routine vaccination for infants and young children with PCV7 vaccine. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American College of Physicians all recommend the PPSV23 vaccine.

Should all nursing home patients ages 65 years and older be vaccinated against pneumococcal disease?
Yes.

Can pregnant women get this vaccine?
The safety of PPSV23 vaccine for pregnant women has not been studied, although no adverse consequences have been reported among newborns whose mothers were vaccinated with pneumococcal polysaccharide vaccine during pregnancy. Women who are at high risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible. Unvaccinated pregnant women who are in a high-risk group should consult with a healthcare professional about getting the vaccination during pregnancy.

How safe is this vaccine?
PPSV23 and PCV7 are both very safe vaccines.

For PPSV23, about 30%-50% of the people who get the vaccine have very mild side effects, such as redness or pain where the shot was given. Fewer than 1% of recipients develop a fever, muscle aches, or more severe local reactions. Serious allergic reactions have been reported very rarely. For PCV7, about 10%-20% of children develop redness, tenderness, or swelling where the shot was given. About 11% may have a mild fever.

How effective is pneumococcal polysaccharide vaccine (PPSV23)?
Overall, PPSV23 is 60%-70% effective in preventing invasive disease. Older adults (e.g., older than age 65 years) and persons with significant underlying illnesses do not respond as well, but vaccination with PPSV23 is still recommended because such persons are at high risk of developing severe pneumococcal disease.

How effective is pneumococcal conjugate vaccine (PCV7)?
In a large clinical trial, PCV7 was shown to be 97% effective in preventing invasive disease caused by the pneumococci contained in the vaccine and 89% effective against all types of S. pneumoniae, including those not found in the vaccine. Children with chronic diseases such as sickle cell disease and HIV infection also seem to respond well to PCV7.

Who should NOT receive pneumococcal vaccine?

• For both PPSV23 and PCV7, persons who had a severe allergic reaction to one dose should not receive another (such reactions are rare).
• Persons who are moderately or severely ill should wait until their condition improves to be vaccinated.

Can the vaccine cause pneumococcal disease?
No. Both PPSV23 and PCV7 are inactivated vaccines containing only a portion of the microbe; therefore the vaccines cannot possibly cause pneumococcal disease.

Questions and answers about pneumococcal disease

Technically reviewed by the Centers for Disease Control and Prevention, April 2009