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Feature Article

Pneumococcal disease and vaccination recommendations. The state of play

Sanjay Jayasinghe
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For older adults without risk factors

A dose of 23vPPV is recommended and fully funded under the NIP for Indigenous adults at 50 years of age and non-Indigenous adults at 65 years of age (Figure 2). These people are still eligible to receive the funded 23vPPV at any age if they have not been vaccinated when reaching these scheduled ages. For older Indigenous adults only, a second dose of 23vPPV is recommended and funded five years after the previous dose. Before 2011 a second 23vPPV dose was recommended for non-Indigenous older adults also, but due to the high rates of local reaction – including some severe injection-site adverse events – ATAGI decided to discontinue the recommendations for a repeat 23vPPV dose except for those with increased risk of pneumococcal disease.

For people with risk factors listed in the Box

For children with underlying medical risk factors (both category A and B), three primary doses of 13vPCV at age 2, 4 and 6 months followed by a booster dose at 12 months of age (i.e. 3+1 schedule) are recommended and funded (Figure 1). After the course of 13vPCV, children with medical risk factors are also funded to receive a dose of 23vPPV at 4 to 5 years of age.

It is recommended that children with a category A risk factor receive a second dose of 23vPPV about five years after the previous 23vPPV dose (i.e. at about 10 years of age) followed by another 23vPPV about 10 years after the previous dose or at about 18 to 20 years of age, whichever is later.

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For all individuals who undergo allogeneic or autologous haematopoietic stem cell transplant, three doses of 13vPCV followed by a dose of 23vPPV are recommended regardless of previous pneumococcal vaccines received. The three doses of 13vPCV are to be given six, eight and 12 months after transplant and the 23vPPV dose 12 months after the last 13vPCV dose.

The recommendation for children with category B risk factors is to give the second dose of 23vPPV about 10 years after the first dose that was given at 4 to 5 years of age (i.e. at age 15 to 18 years).

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People may be diagnosed with these risk factors at different ages. The schedule to follow varies according to the age, whether the person is Indigenous or non-Indigenous, their risk factor category (A or B) and what pneumococcal vaccines, if any, they have received already. Table 2 summarises the recommendations for those who have risk factors diagnosed between the ages of 5 and 18 years. Of note, if the person has a category A risk factor then a dose of 13vPCV is to be offered if it has not been given previously. Thereafter, 23vPPV is to be given at the specified intervals.

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