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Feature Article

Pneumococcal disease and vaccination recommendations. The state of play

Sanjay Jayasinghe
OPEN ACCESS

There are two pneumococcal vaccines available in Australia through the National Immunisation Program (NIP):

  • Prevenar 13 (Pfizer), 13-valent pneumococcal conjugate vaccine (13vPCV).
  • Pneumovax 23 (Seqirus/Merck), 23-valent pneumococcal polysaccharide vaccine (23vPPV).

Recommendations of the Australian Technical Advisory Group on Immunisation (ATAGI) regarding the use of pneumococcal vaccines are published in the Australian immunisation handbook (https://immunisationhandbook.health.gov.au).26 These recommendations regarding which vaccine to use and the required number of doses and timing are based on the different characteristics of the vaccines and a person’s individual risk of IPD. An individual’s risk of IPD varies by:

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  • age
  • Indigenous status
  • state/territory of residence
  • the presence and nature of risk factors, including both immunocompromising and nonimmunocompromising  underlying medical and selected  behavioural conditions
  • previous doses of pneumococcal  vaccines received.

Table 1 summarises important details regarding pneumococcal vaccines currently available in Australia.

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Most of the ATAGI-recommended pneumococcal vaccine doses are fully funded by the government under the NIP, and for some recommendations the vaccine cost is subsidised under the PBS. People occasionally have to pay the full cost of the vaccine.

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Risk factors for pneumococcal disease

Certain medical and lifestyle conditions are associated with increased risk of pneumococcal infection as well as more severe disease outcomes across populations . After they were licensed, pneumococcal vaccines were offered to those population groups at high risk of IPD; the specific recommendations for additional vaccine doses for those groups are still in place but compliance seems poor. Studies have shown that pneumococcal vaccines led to a decline in IPD caused by serotypes targeted by the vaccines in some of these groups, but the decline is less than that observed among people with no such risk conditions (risk factors).27,28 As a result, in this post-PCV era a large proportion of pneumococcal disease in children and adults is in those with risk factors. Individuals with risk factors are susceptible to disease caused by a broader range of pneumococcal serotypes than those with no risk factors.29,30 The use of 23vPPV is recommended for these people to account for this.

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Dr Jayasinghe is a Medical Epidemiologist and Research Fellow at the National Centre for Immunisation Research and Surveillance, Sydney, NSW.