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Pneumococcal vaccine… more than a defense against pneumonia!

June 21, 2022
What is pneumococcal disease?
Pneumococcal disease is a bacterial infectious disease caused by Streptococcus pneumoniae (S. pneumoniae), sometimes known as pneumococcus, which is a vaccine-preventable disease. Pneumococcal infections can range from ear and sinus infections to serious infections such as lung infection (pneumonia), bloodstream infection (bacteremia), and brain infection (meningitis), which can lead to coma and death.

 
Symptoms of pneumococcal disease
 
The symptoms and severity depend on which part of the body is infected.
  • Middle ear infection: sore ear(s), hearing loss and fever
  • Sinus infection: sore face, blocked nose, headaches and a yellow-green mucus
  • Lung infection: fever, cough, chest pain and problems breathing
  • Bloodstream infection: fever, muscle aches and pains, and headaches
  • Brain and spinal cord infection: high fever, headache, nausea, vomiting, stiff neck and coma


Who is at risk?
  • Adults 65 years or older
  • Adults of all ages are also at increased risk if they have:
    • Alcoholism
    • Chronic heart, lung, kidney, or liver disease
    • Cochlear implant
    • Cerebrospinal fluid (CSF) leak
    • Diabetes
    • HIV infection, cancer, solid organ transplant, or another condition or taking medicine that weakens the immune system
    • Nephrotic syndrome
    • Sickle cell disease, a damaged spleen, or no spleen
    • Cigarette smoking
 
How can you prevent pneumococcal disease?
Pneumococcal disease can be prevented by maintaining a healthy lifestyle or avoiding contact with the patient. Moreover, vaccination is the recommended way to reduce the risk of infection.

 
Pneumococcal vaccine in Thailand
 
There are 2 types of pneumococcal vaccines available in Thailand which cover different types of bacteria:
 1. Pneumococcal conjugate vaccine (PCV13) This vaccine helps protect against 13 types of pneumococcal bacteria that can cause serious infections in children and half of adults.
2. Pneumococcal polysaccharide vaccine (PPSV23) This vaccine helps protect against serious infections caused by 23 types of pneumococcal bacteria.

Never administer two types of pneumococcal vaccines in the same visit. If a decision to administer PCV13 is made, it should be administered before PPSV23.
 
How many doses of pneumococcal vaccine do you need?
 
Recommended pneumococcal vaccines for adults can divided in 2 groups of adult:
  • Groups 1: 19-64 years old (as in Table 1)
  • Groups 2: 65 years old and older (as in Table 2)
   
 Table 1: 19-64 years old
 Underlying medical conditions or other risk factors  PCV13  PPSV23
 Recommended
(Dose 1)
 Revaccination
(Dose 2)
 None  🗙  🗙  🗙
 Immunocompetent adults with:
  • Alcoholism
  • Chronic heart disease
  • Chronic lung disease
  • Chronic liver disease
  • Diabetes mellitus
  • Cigarette smoking
 ✔*
 
 ✔
At least 1 year after PCV13
 🗙
 Immunocompetent adults with:
  • Cochlear implant
  • Cerebrospinal fluid (CSF) leak
 ✔
 ✔
At least 8 weeks after PCV13
 🗙
 Immunocompromised adults with:
  • Chronic renal failure
  • Congenital or acquired asplenia
  • Congenital or acquired immunodeficiency
  • Generalized malignancy
  • HIV infection
  • Hodgkin disease
  • Iatrogenic immunosuppression
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Nephrotic syndrome
  • Sickle cell disease or other hemoglobinopathies
  • Solid organ transplant
 ✔
 ✔
At least 8 weeks after PCV13
 ✔
At least 5 years after first PPSV23
🗙: Not recommended, ✔: 1 dose, * Under physician consideration

 
Table 2: 65 years old and older
Underlying medical conditions or other risk factors PCV13 PPSV23
None
At least 1 year after PCV13
Immunocompetent adults with:
  • Alcoholism
  • Chronic heart disease
  • Chronic lung disease
  • Chronic liver disease
  • Diabetes mellitus
  • Cigarette smoking
if no previous PCV13
At least 1 year after PCV13 and at least 5 years after last PPSV23 at < 65 years
Immunocompetent adults with:
  • Cochlear implant
  • Cerebrospinal fluid (CSF) leak
At least 8 weeks after PCV13 and at least 5 years after last PPSV23 at < 65 years
Immunocompromised adults with:
  • Chronic renal failure
  • Congenital or acquired asplenia
  • Congenital or acquired immunodeficiency
  • Generalized malignancy
  • HIV infection
  • Hodgkin disease
  • Iatrogenic immunosuppression
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Nephrotic syndrome
  • Sickle cell disease/other hemoglobinopathies
  • Solid organ transplant
if no previous PCV13 vaccination
At least 8 weeks after PCV13 and at least 5 years after last PPSV23 at < 65 years
✔: 1 dose


What are the possible side effects of this vaccine?
Mostly, side effects are mild such as redness, swelling, and pain or tenderness at the injection site. This might also be accompanied by feeling tired, fever, headache and muscle aches. If these problems occur, they usually go away within about 2-3 days.

 
How important is the pneumococcal vaccine during COVID-19 pandemic?
During the COVID-19 pandemic, many reports have claimed that S. pneumoniae is the most common coinfecting bacteria in COVID-19 patients which can cause more severe infection, and can lead to coma and death. The weakening of immune function caused by COVID-19 remains a high-risk factor for pneumococcal disease. Thus, pneumococcal vaccination during the COVID-19 pandemic has become more important than ever.
 

 
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