Advertisement
Feature Article

Pneumococcal disease and vaccination recommendations. The state of play

Sanjay Jayasinghe
OPEN ACCESS

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.

Advertisement
Advertisement

Conclusion

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

Advertisement
Advertisement

 

Advertisement
Advertisement

COMPETING INTERESTS: None.

 

References

1.    O’Brien K, Wolfson L, Watt J, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009; 374: 893-902.
2.    Wahl B, O’Brien KL, Greenbaum A, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Health 2018; 6: e744-e757.
3.    Black S, Eskola J, Whitney C, Shinefield H. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier; 2008: 531-568.
4.    Bjornson GL, Scheifele DW, Halperin SA. Population-based epidemiology of invasive pneumococcal infection in children in nine urban centers in Canada, 1994 through 1998. Pediatr Infect Dis J 2002; 21: 947-950.
5.    Jefferson T, Ferroni E, Curtale F, Giorgi Rossi P, Borgia P. Streptococcus pneumoniae in western Europe: serotype distribution and incidence in children less than 2 years old. Lancet Infect Dis 2006; 6: 405-410.
6.    McIntyre PB, Gilmour RE, Gilbert GL, Kakakios AM, Mellis CM. Epidemiology of invasive pneumococcal disease in urban New South Wales, 1997-1999. Med J Aust 2000; 173(Suppl): S22-S26.
7.    Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: opportunities for prevention in the conjugate vaccine era. JAMA 2001; 285: 1729-1735.
8.    Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344: 403-409.
9.    Said MA, Johnson HL, Nonyane BA, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One 2013; 8: e60273.
10.    AlonsoDeVelasco E, Verheul AF, Verhoef J, Snippe H. Streptococcus pneumoniae: virulence factors, pathogenesis, and vaccines. Microbiol Rev 1995; 59: 591-603.
11.    Kaplan Sl, Barson WJ, Lin Pl, et al. Serotype 19A is the most common serotype causing invasive pneumococcal infections in children. Pediatrics 2010; 125: 429-436.
12.    Richter SS, Heilmann KP, Dohrn CL, Riahi F, Diekema DJ, Doern GV. Pneumococcal serotypes before and after introduction of conjugate vaccines, United States, 1999-2011. Emerg Infect Dis 2013; 19: 1074-1083.

Pages

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