Pneumococcal polysaccharide vaccine
Encyclopedia
Pneumococcal polysaccharide vaccine (PPSV) — the latest version is known as Pneumovax 23 (PPV-23) — is the first pneumococcal vaccine
, the first vaccine derived from a capsular polysaccharide, and an important landmark in medical history. The polysaccharide antigens were used to induce type-specific antibodies that enhanced opsonization, phagocytosis, and killing of pneumococci by phagocytic cells. The pneumococcal polysaccharide vaccine is widely used in high-risk adults. As a result, there has been important reductions in the incidence, morbidity, and mortality from pneumococcal pneumoniae and invasive pneumococcal disease.
First used in 1945, the tetravalent vaccine was not widely distributed, since its deployment coincided with the discovery of penicillin. In the 1970s, Robert Austrian
championed the manufacture and distribution of a 14-valent PPSV. This evolved in 1983 to a 23-valent formulation (PPSV23). A significant breakthrough impacting the burden of pneumococcal disease was the licensing of a protein conjugate heptavalent vaccine (PCV7) beginning in February 2000.
, PPSV is recommended for adults 65 years of age or older, adults with serious long-term health problems, smokers, and children older than two years with serious long-term health problems. The World Health Organization
recommendations are similar. The WHO does not recommend use of PPV in routine childhood immunization programs.
In the United Kingdom
, PPV is recommended (as a part of routine vaccination schedule
s) for those over the age of 65, as well as for both children and adults in special risk categories:
In March 2011, The Joint Committee on Vaccination and Immunisation (JCVI) advised to stop using pneumococcal polysaccharide vaccine (PPV), for those aged 65 years and older. PPV should however still be offered to those in clinical risk groups.
PPSV is important for HIV patients. In Canadian HIV
patients, the vaccine has been reported to decrease the incidence of invasive pneumococcal disease from 768/100,000 person-years to 244/100,000 patient-years. Current WHO guidelines recommend immunization with PPV-23 for HIV patients in clinical stage 1, while the CDC recommends immunization in those with a CD4 cell count greater than 200/μL.
s 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F) and so covers 90 percent of the types found in pneumococcal bacteraemia.
Special risk-group:Children at special risk (e.g. sickle cell disease and asplenia) require as full protection as can be achieved using the 13-valent congugated vaccine, with the then more extensive 23-valent vaccine given after the second year of life:
Pneumococcal vaccine
A pneumococcal vaccine is a vaccine against Streptococcus pneumoniae.Types include:* Pneumococcal polysaccharide vaccine* Pneumococcal conjugate vaccine-Vaccination in the USA:...
, the first vaccine derived from a capsular polysaccharide, and an important landmark in medical history. The polysaccharide antigens were used to induce type-specific antibodies that enhanced opsonization, phagocytosis, and killing of pneumococci by phagocytic cells. The pneumococcal polysaccharide vaccine is widely used in high-risk adults. As a result, there has been important reductions in the incidence, morbidity, and mortality from pneumococcal pneumoniae and invasive pneumococcal disease.
First used in 1945, the tetravalent vaccine was not widely distributed, since its deployment coincided with the discovery of penicillin. In the 1970s, Robert Austrian
Robert Austrian
Robert Austrian was an American infectious diseases physician and, along with Maxwell Finland, one of the 2 most important researchers into the biology of Streptococcus pneumoniae in the 20th century....
championed the manufacture and distribution of a 14-valent PPSV. This evolved in 1983 to a 23-valent formulation (PPSV23). A significant breakthrough impacting the burden of pneumococcal disease was the licensing of a protein conjugate heptavalent vaccine (PCV7) beginning in February 2000.
Indications
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, PPSV is recommended for adults 65 years of age or older, adults with serious long-term health problems, smokers, and children older than two years with serious long-term health problems. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
recommendations are similar. The WHO does not recommend use of PPV in routine childhood immunization programs.
In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, PPV is recommended (as a part of routine vaccination schedule
Vaccination schedule
A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence....
s) for those over the age of 65, as well as for both children and adults in special risk categories:
- Serious breathingRespiratory diseaseRespiratory disease is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the...
problems, including AsthmaAsthmaAsthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
and COPDChronic obstructive pulmonary diseaseChronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases... - Serious heart conditions, such as Congestive heart failureCongestive heart failureHeart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...
- Severe kidneyKidneyThe kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
problems - Long term liver diseaseLiver diseaseLiver disease is a broad term describing any single number of diseases affecting the liver.-Diseases:* Hepatitis, inflammation of the liver, caused mainly by various viruses but also by some poisons , autoimmunity or hereditary conditions...
- Diabetes requiring medication
- ImmunosuppressionImmunosuppressionImmunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...
due to disease (e.g. HIVHIVHuman immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDSAIDSAcquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
or lupusSystemic lupus erythematosusSystemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
) or treatment (e.g. chemotherapy or radio therapy, long-term steroid use, and problems with the spleenSpleenThe spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
(aspleniaAspleniaAsplenia refers to the absence of normal spleen function and is associated with some serious infection risks. Hyposplenism is used to describe reduced splenic functioning, but not as severely affected as with asplenism.-Congenital:...
), either because the spleen has been removed (splenectomySplenectomyA splenectomy is a surgical procedure that partially or completely removes the spleen.-Indications:The spleen, similar in structure to a large lymph node, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cells and platelets, and the detection and fight...
) or does not work properly (for example, due to sickle cell disease).
In March 2011, The Joint Committee on Vaccination and Immunisation (JCVI) advised to stop using pneumococcal polysaccharide vaccine (PPV), for those aged 65 years and older. PPV should however still be offered to those in clinical risk groups.
PPSV is important for HIV patients. In Canadian HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
patients, the vaccine has been reported to decrease the incidence of invasive pneumococcal disease from 768/100,000 person-years to 244/100,000 patient-years. Current WHO guidelines recommend immunization with PPV-23 for HIV patients in clinical stage 1, while the CDC recommends immunization in those with a CD4 cell count greater than 200/μL.
Risks
Approximately half of people who receive PPSV experience pain and soreness at the vaccination site. Fewer than one percent develop a fever and/or muscle aches.Adults and children over two years of age
The 23-valent vaccine (e.g., Pneumovax 23) is effective against 23 different pneumococcal capsular types (serotypeSerotype
Serotype or serovar refers to distinct variations within a subspecies of bacteria or viruses. These microorganisms, viruses, or cells are classified together based on their cell surface antigens...
s 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F) and so covers 90 percent of the types found in pneumococcal bacteraemia.
Young children
Children under the age of two years fail to mount an adequate response to the 23-valent adult vaccine, and instead a 13-valent Pneumococcal Conjugated Vaccine (PCV) (e.g. Prevnar 13) must be used. Prevnar 13 is a new vaccine which has replaced Prevnar 7, adding six new serotypes to the vaccine. While this covers only thirteen strains out of more than ninety strains, these thirteen strains caused 80 percent to 90 percent of cases of severe pneumococcal disease in the US before introduction of the vaccine, and it is considered to be nearly 100 percent effective against these strains.Special risk-group:Children at special risk (e.g. sickle cell disease and asplenia) require as full protection as can be achieved using the 13-valent congugated vaccine, with the then more extensive 23-valent vaccine given after the second year of life:
| Age | 2–6 months | 7–11 months | 12–23 months |
| Conjugated vaccine | 3 x monthly dose | 2 x monthly dose | 2 doses, 2 months apart |
| Further dose in second year of life | |||
| 23-valent vaccine | Then after 2nd birthday single dose of 23-valent | ||
External links
- Pneumococcal Vaccines World Health Organization (WHO)
- Pneumovax 23 information Merck
- Pneumovax package insert Merck
- PATH's Vaccine Resource Library pneumococcus resources