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Feature Article

Pneumococcal disease and vaccination recommendations. The state of play

Sanjay Jayasinghe
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Among Australian children, the two PCVs that have been used in the universal infant pneumococcal vaccination program, 7vPCV and 13vPCV, are highly efficacious. The three-dose schedule of both vaccines had more than 90% effectiveness in children against IPD caused by serotypes they contained.48,49 These vaccine effectiveness assessments showed that without a booster dose vaccine-induced immunity waned when children reach their second year of life.49,50 This led to ATAGI revising the schedule for 13vPCV by moving the third dose given at 6 months of age to be a booster dose at 12 months of age to prolong immunity. The PCV programs also led to large declines in IPD caused by vaccine serotypes in unvaccinated older children and adults, mediated through reduction in asymptomatic carriage of pneumococcus in vaccinated children. The 23vPPV vaccine offered to older adults had 61% effectiveness against IPD caused by serotypes covered in that vaccine in Australian adults aged 65 years and over.51 In recent IPD notifications data, about 40% of cases in children under 5 years of age were caused by 13vPCV serotypes.43

Current pneumococcal vaccination strategy in Australia

The Australian immunisation handbook digital version contains the current ATAGI recommendations for pneumococcal vaccination.26 They are summarised below according to age and risk-factor status. The ATAGI recommendations differ in some ways from the manufacturers’ product information. Previous anaphylaxis with vaccine or components is an absolute contraindication to vaccination.

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For children without risk factors

For all non-Indigenous children and Indigenous children in the ACT, NSW, Tasmania or Victoria without any of the risk factors listed in the Australian immunisation handbook (Box), three doses of 13vPCV at ages 2 months, 4 months and 12 months (2+1 schedule) are recommended and funded (Figure 1). It is also recommended that the first dose can be given at 6 weeks of age, at the same time as the first dose of pertussis-containing vaccine. Those infants should still receive their next scheduled dose at age 4 months. Before 1 July 2018, the schedule recommended for these children was three primary doses at ages 2, 4 and 6 months. The third primary dose was then moved to become a booster dose in order to make vaccine-induced protection last longer. During the transition period, it was recommended that children who had already received three doses of 13vPCV who reached the age of 12 months after 1 July 2018 also receive the booster dose at 12 months of age. Having this booster dose in the 13vPCV schedule is expected to also substantially improve herd protection. 

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For Indigenous children living in the NT, Queensland, SA and WA, a booster dose of 13vPCV after three primary doses at 2months, 4 months and 6 months of age is recommended and funded (3+1 schedule). This booster dose was previously given at age 12 months in SA and 18 months in NT, Queensland and WA. The recommended schedule point for the 13vPCV booster for all eligible children from 1 July 2018 onwards is 12 months of age.

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For children who have a delayed start to their vaccination and for those missing doses, the schedule to follow depends on their age at presentation; the Australian immunisation handbook stipulates the number and timing of 13vPCV doses in these scenarios. No pneumococcal vaccine doses are recommended for children after 5 years of age unless they have underlying risk conditions, owing to the otherwise relatively low risk of pneumococcal disease.

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