Feature Article

Pneumococcal disease and vaccination recommendations. The state of play

Sanjay Jayasinghe

It is recommended that all adults (Indigenous and non-Indigenous) aged 18 years or over who have risk conditions (either category A or B) receive up to three lifetime doses of 23vPPV (Figure 2 and Table 3). For adults with Category A risk factors a single dose of 13vPCV is recommended if they have not previously received any dose of 13vPCV, although this is not currently subsidised. If the person has received a dose of 23vPPV previously, the recommended interval before the 13vPCV dose is 12 months. Thereafter, a dose of 23vPPV is recommended after an interval of at least two months and at least five years since the last dose of 23vPPV. The next 23vPPV dose is recommended at about five to 10 years (minimum five years) after the previous 23vPPV dose. For Indigenous adults the third and final dose of 23vPPV is recommended at age 50 years or at least five years after the second dose (whichever is later). For non-Indigenous adults, the third and final dose of 23vPPV is recommended at 65 years of age or at least five years after the second dose (whichever is later).

If adults with category A risk conditions present for their first pneumococcal vaccination at or after 50 years of age, if Indigenous, and 65 years of age, if non-Indigenous, a dose of 13vPCV followed by up to three doses of 23vPPV vaccine are to be given conforming to the intervals described above. For Indigenous adults the third dose is to be given at a minimum of 65 years of age. If the adult has a category B risk factor then two doses of 23vPPV are recommended.



The pneumococcal vaccination program targeting all infants and older adults and individuals with risk conditions led to large reductions in the severe form of pneumococcal disease overall. However, currently a disproportionate burden of pneumococcal disease is borne by Indigenous adults and people with risk conditions. Although there are vaccination recommendations specifically targeting groups at high risk, it is likely that uptake is suboptimal. The susceptibility of  these high risk groups to disease caused by a broader range of pneumococcal serotypes compounds the problem. Recent changes to the infant 13vPCV schedule will lead to longer-lasting protection in vaccinated children and better herd effect, benefitting all. Vaccine providers need to particularly focus on ensuring that all people with risk conditions are identified and given the full course of recommended pneumococcal vaccine doses.    RMT







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