What is pneumococcal disease?
Pneumococcal disease is a bacterial infection caused by streptococcus pneumoniae of which there are more than 90 serotypes. The organism is frequently found in the upper respiratory tract of healthy individuals worldwide. It has been estimated that carriage of the bacteria may range from 10% of adults to 50% of children attending day care facilities.
Over the years streptococcus pneumoniae has become resistant to many medications making the treatment of pneumococcal infections much more difficult. Prevention of disease through vaccination is now more important than ever.
What are the symptoms of pneumococcal disease?
Pneumococcal infection is responsible for 50% of community acquired pneumonia and bacteraemia where the overall mortality rate can be as high as 25%. It can also cause a wide variety of other infections including sinusitis, osteomyeltitis, bronchitis and otitis media.
Who is most at risk of pneumococcal disease?
Pneumococcal disease can lead to significant morbidity and mortality, particularly amongst the very young, the very old, those with impaired immunity and those with anatomic or functional asplenia.
How is pneumococcal disease transmitted?
Transmission requires close contact with cases or carriers and is by droplet infection. Person-to person transmission of the organism is common. The incubation period can be difficult to determine but can be as short as 1-3 days.
Which pneumococcal vaccines are recommended in Ireland?
Pneumococcal conjugate vaccines and pneumococcal polysaccharide vaccines are licensed in Ireland
Pneumococcal conjugate vaccine (PCV)
PCV 13 - Prevenar 13 - contains polysaccharide from 13 of the most common capsular types(1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F). It is recommended for the routine vaccination of all children born on or after 1st October 2010. This replaced PCV 7 (Prevenar 7) the pneumococcal conjugate vaccine introduced into the routine childhood immunisation programme in September 2008.
Pneumococcal polysaccharide vaccine (PPV23)
This vaccine contains purified polysaccharide from 23 of the most common capsular types of streptococcus pneumoniae. This vaccine is recommended for those aged 65 years and older and “at-risk” adults and children over 2 years of age.
What impact has PCV7 had?
The introduction of PCV7 into the childhood immunisation schedule in the US in early 2000 resulted in a 69% reduction in the rates of invasive pneumococcal disease (IPD).
In Ireland the burden of IPD has also declined since the introduction of PCV7 to the childhood immunisation schedule in September 2008. It resulted in an 83% decease in the incidence of IPDv in those aged under 2 years caused by the PCV7 vaccine serotypes.
In 2009 the incidence of confirmed cases of IPD declined by 12% compared with 2008 (with a 37% reduction in the <2 year old population) (Figure 1).
Figure 1. Age specific incidence rates (ASIR) of invasive pneumococcal disease notifications, 2004-2009 Source: Health Protection Surveillance Centre.
Why is PCV 13 being introduced into the routine childhood schedule?
PCV 13 provides protection against the same strains as PCV7 as well as additional protection from six serotypes of pneumococcal disease.
PCV13 has already been introduced into the routine childhood schedules of other countries such as the United Kingdom
Why introduce PCV13 for babies born on or after October 1st 2010?
This date was chosen so all babies born during Quarter 4 2010 and later will receive a full course of PCV13. We will then be able to assess the impact of the new vaccine in line with the quarterly vaccine uptake figures produced by Health Protection Surveillance Centre (HPSC).
Who should NOT receive PCV13?
Children should not get PCV13 if
They had a serious (life –threatening) allergic reaction to a previous dose or any of its constituents. They had a serious (life –threatening) allergic reaction to PCV7 vaccine or any of its constituents.
When should vaccination be postponed?
As for any vaccine PCV vaccination should be postponed in those individuals who have an acute febrile illness.
What should one expect after vaccination with PCV 13?
In studies, most reactions after PCV13 were mild. They were similar to reactions reported after PCV7, which has been in use since 2000 in the US. Reported reactions varied by dose and age, but on average:
About half of children were drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where the shot was given. About 1 out of 3 had swelling where the shot was given. About 1 out of 3 had a mild fever
What about children in at risk groups who have previously completed a course of PCV7?
A single dose of PCV13 may be given opportunistically to children under 5 years of age who are in an “at risk” group and who have completed a course of PCV7. They should also receive pneumococcal polysaccharide vaccine (PPV23).
Who are in the at risk groups that should be offered PCV13?
Children up to 5 years of age with the following are at increased risk of pneumococcal infection.
Asplenia or splenic dysfunction (including surgical splenectomy, sickle cell disease and coeliac disease) Chronic renal disease or nephrotic syndrome or renal transplant Chronic heart, lung, or liver disease, including cirrhosis Diabetes mellitus Complement deficiency (particularly early component deficiencies C1, C2, C3, C4) Immunosuppressive conditions (e.g. some B- and T-cell disorders, HIV infection, leukaemia, lymphoma, Hodgkin’s disease) and those receiving immunosuppressive therapies.
Note: Individuals with primary immunodeficiency may have a suboptimal response to vaccines. The vaccines are unlikely to be immunogenic in children with certain primary immune deficiencies involving significant B cell compromise and who are receiving regular IVIG replacement therapy.
CSF leaks either congenital or complicating skull fracture or neurosurgery Intracranial shunt Candidates for, or recipients of, a cochlear implant Children under 5 years of age with a history of invasive pneumococcal disease, irrespective of vaccine history.
Children between the ages of 5 and 18 years at higher risk of pneumococcal infection
- Immunisation with PCV 13 followed by immunisation with PPV 23 is recommended for children up to 5 years of age
- Children 5-18years should be given one dose of PPV23
- PCV13 may be used in those 5-18 years who are significantly increased risk of IPD regardless of previous history of PPV23 or PCV7
Has the National Immunisation Advisory Committee (NIAC) issued new guidance on pneumococcal infection and vaccination to include PCV13?
Yes. NIAC has issued new guidance on pneumococcal infection and vaccination. This is available to download from
www.immunisation.ie
www.rcpi.ie
www.hpsc.ie |
