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.
 

• What is pneumococcal disease?
• Symptoms of pneumococcal disease
• Who is at risk?
• How can you prevent pneumococcal disease?
• Pneumococcal vaccine in Thailand
• How many doses of pneumococcal vaccine do you need?
• What are the possible side effects of this vaccine?
• How important is the pneumococcal vaccine during COVID-19 pandemic?

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 (PCV10, PCV13, PCV15 and PCV20) These vaccines helps protect against 10, 13, 15 or 20 types of pneumococcal bacteria that can cause serious infections in children and half of adults.

PCV20 is a new pneumococcal conjugate vaccine in Thailand. It protects against pneumococcus types 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, 33F (which are included in PCV15) plus 8, 10A, 11A, 12F and 15B.

 

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 or PCV15 is made, it should be administered before PPSV23.

 

How many doses of pneumococcal vaccine do you need?

For children
All children younger than 5 years old should be given 4 doses of pneumococcal conjugate vaccine (PCV13/15/20) at ages 2, 4, 6, and 12 through 15 months.

For adults 
Recommended pneumococcal vaccines for adults can divided in 2 groups of adult:

• Groups 1: 19-49 years old (as in Table 1)
• Groups 2: 50 years old and older (as in Table 2)

   

Table 1: 19-49 years old
Underlying medical conditions or other risk factors	PCV13/15/20*	PPSV23
None	🗙	🗙
Immunocompetent adults with: Alcoholism Chronic heart disease Chronic lung disease Chronic liver disease Diabetes mellitus Cigarette smoking	✔	✔** At least 1 year after PCV13/15
Immunocompetent adults with: Cochlear implant Cerebrospinal fluid (CSF) leak	✔	✔** At least 8 weeks after PCV13/15
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 PCV13/15 and at least 5 years after last PPSV23

🗙: Not recommended, ✔: 1 dose

* When PCV20 is used, their pneumococcal vaccinations are complete.
** If PPSV23 is not available, PCV20 may be used.

 

Table 2: 50 years old and older
Underlying medical conditions or other risk factors	PCV13/15/20*	PPSV23
None	✔	✔ At least 1 year after PCV13/15
Immunocompetent adults with: Alcoholism Chronic heart disease Chronic lung disease Chronic liver disease Diabetes mellitus Cigarette smoking	✔ if no previous PCV13/15/20	✔ At least 1 year after PCV13/15 and at least 5 years after last PPSV23
Immunocompetent adults with: Cochlear implant Cerebrospinal fluid (CSF) leak		✔ At least 8 weeks after PCV13/15 and at least 5 years after last PPSV23
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 PCV13/15/20	✔ At least 8 weeks after PCV13/15 and at least 5 years after last PPSV23

✔: 1 dose
* When PCV20 is used, their pneumococcal vaccinations are complete.

For individuals aged 65 years and older who have already received PCV13 at any age and PPSV23 at or after the age of 65 years old, an additional dose of PCV20 may be considered by their physician, at least 5 years after the last pneumococcal vaccine.

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, loss of appetite, fever, headache and muscle aches. If these problems occur, they usually go away within about 2-3 days.
 
 

Who might not be able to get this vaccine?

Anyone with a severe, life-threatening allergy to any part of the pneumococcal vaccine should not get the vaccine. People who have a more serious illness should probably wait until they recover before receiving the vaccine.
 
 

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.