Intervals Between Pcv13 And Ppsv23 Vaccines: Recommendations Of The Advisory Committee On Immunization Practices
Please note: Anerratum has been published for this article. To view the erratum, please click here.
Miwako Kobayashi, MD1,2 Nancy M Bennett, MD3,4 Ryan Gierke, MPH1 Olivia Almendares, MSPH1 Matthew R Moore, MD1 Cynthia G. Whitney, MD1 Tamara Pilishvili, MPH1
Two pneumococcal vaccines are currently licensed for use in the United States: the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine . The Advisory Committee on Immunization Practices currently recommends that a dose of PCV13 be followed by a dose of PPSV23 in all adults aged 65 years who have not previously received pneumococcal vaccine and in persons aged 2 years who are at high risk for pneumococcal disease because of underlying medical conditions . The recommended intervals between PCV13 and PPSV23 given in series differ by age and risk group and the order in which the two vaccines are given .
On June 25, 2015, ACIP changed the recommended interval between PCV13 followed by PPSV23 from 612 months to 1 year for immunocompetent adults aged 65 years. Recommended intervals for all other age and risk groups remain unchanged. This report outlines the rationale for this change and summarizes the evidence considered by ACIP to make this recommendation.
The Different Types Of Pneumococcal Vaccine
The type of pneumococcal vaccine you’re given depends on your age and health. There are 2 types.
Pneumococcal conjugate vaccine is used to vaccinate children under 2 years old as part of the NHS vaccination schedule. It’s known by the brand name Prevenar 13.
Children at risk of pneumococcal infections can have the PPV vaccine from the age of 2 years onwards. The PPV vaccine is not very effective in children under the age of 2.
Who Needs The Pneumococcal Vaccine
The Centers for Disease Control and Prevention recommends the PPSV23 vaccine for all adults 65 years or older as well as adults 19 years or older with certain medical conditions that could put them at greater risk of infection. The PCV13 vaccine, on the other hand, should be a shared decision between the patient and clinician due to additional medical considerations.
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Who Needs One Or Two Pneumonia Vaccines
There are two pneumococcal vaccines, each working in a different way to maximize protection. PPSV23 protects against 23 strains of pneumococcal bacteria. Those 23 strains are about 90- to 95-plus percent of the strains that cause pneumonia in humans, Poland explains. PCV13, on the other hand, is a conjugate vaccine that protects against 13 strains of pneumococcal bacteria. PCV13 induces immunologic memory, he says. Your body will remember that it has encountered an antigen 20 years from now and develop antibodies to fight it off.
In order to get the best protection against all strains of bacteria that cause pneumonia, the CDC has long recommended that everyone 65 or older receive both vaccines: PCV13 , followed by the pneumococcal polysaccharide vaccine at a later visit. But the agency is now saying that PCV13 may not be necessary for healthy people 65 and older, suggesting that the decision be left up to patients and their physicians as to whether that extra skin prick is appropriate.
“Anyone who reaches the age of 65 and is in any way immunocompromised or has any of the listed indications for pneumococcal vaccine because they’re in a high-risk group for example, if they have diabetes, heart disease or lung disease, or are a smoker should continue to get both vaccines, says Schaffner.
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Tetanus Diphtheria And Pertussis
The tetanus, diphtheria, and pertussis vaccine combined is recommended if you have not received a tetanus shot in the last 10 years or have only had the tetanus and diphtheria combined vaccine and not the Tdap in the past.
Tetanus is caused by a bacteria in soil, dirt and manure and can impair the nervous system. Diphtheria is caused by a bacteria that attaches to the lining of the respiratory system, which causes difficulty breathing and swallowing and can get into the bloodstream and damage the heart, kidneys and nerves. Pertussis can be a very serious disease, especially for vulnerable populations, such as infants, young children and older adults. Pertussis causes coughing fits due to the bacteria attaching to the lining of the upper respiratory system.
The vaccine is greater than 95 percent effective in preventing tetanus and diphtheria and 70 percent effective in preventing pertussis. You can get this vaccine from your health care provider.
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Flu And Pneumonia Shots
Having the flu can be dangerous for anyone. But it is extra risky for people with diabetes or other chronic health problems. Having diabetes means having more instances of high blood sugar than a person without diabetes. High blood sugar hinders your white blood cells ability to fight infections.
Beyond people living with diabetes, flu is also extra risky for people with heart disease, smokers and those with chronic lung disease, people who have an impaired immune system , very young children, and people living in very close quarters, such as college dorms, military barracks, or nursing homes.
Babies And The Pneumococcal Vaccine
Babies are routinely vaccinated with a type of pneumococcal vaccine known as the pneumococcal conjugate vaccine as part of their childhood vaccination programme.
Babies born on or after 1 January 2020 have 2 injections, which are usually given at:
- 12 weeks old
- 1 year old
Babies born before this date will continue to be offered 3 doses, at 8 and 16 weeks and a booster at 1 year.
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Who Should Not Get These Vaccines
Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below specific to pneumococcal vaccines and ask your or your childs doctor for more information.
Children younger than 2 years old should not get PPSV23. In addition, tell the person who is giving you or your child a pneumococcal conjugate vaccine if:
You or your child have had a life-threatening allergic reaction or have a severe allergy.
- Anyone who has had a life-threatening allergic reaction to any of the following should not get PCV13:
- A shot of this vaccine
- An earlier pneumococcal conjugate vaccine called PCV7
- Any vaccine containing diphtheria toxoid
You or your child are not feeling well.
- People who have a mild illness, such as a cold, can probably get vaccinated. People who have a more serious illness should probably wait until they recover. Your or your childs doctor can advise you.
When Is The Pneumonia Vaccine Given
The pneumonia vaccine is not the same as the flu vaccine, as it doesnt need to be given at a certain time of year. Rather, it can be given at any time, as long as its safe for you to have it.
However, if youre in a high-risk group for pneumonia, you should get the vaccine as soon as possible to make sure youre protected.
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Questions To Ask Your Doctor
- When should I make an appointment to get each type of pneumococcal vaccine?
- Should I still get the vaccines if Ive recently had pneumonia?
- Should I wait to turn 65 before I get each dose of pneumococcal vaccines?
- If I have a negative reaction to one type of pneumococcal vaccine, am I likely to have that same reaction to the other?
Funding was provided for these pneumococcal resources through an unrestricted grant from Pfizer Independent Grant for Learning and Change .
I Got A Pneumonia Shot And Then The Pain Began
Last December during a routine physical exam, I received a vaccination to protect against several strains of pneumonia. It hurt, more so than the usual injection. In the days that followed, the pain in my left shoulder worsened. Initially, I dismissed it as typical post-shot soreness. But it didnt go away.
All these months later, it still hurts. My orthopedist says I have subacromial bursitis, which is chronic inflammation and excess fluid buildup in the bursa separating the acromion bone at the top of the shoulder from the rotator cuff.
Im convinced this occurred because the nurse injected the vaccine too high on my arm. I had no symptoms before the shot, and pain has persisted since. The needle probably entered the top third of the deltoid muscle which forms the rounded contours of the shoulder and probably went into the bursa or the rotator cuff, instead of lower down, into the middle part of the muscle, missing the bursa and rotator cuff entirely. I say probably because I wasnt watching. Like many, I avert my eyes at the sight of an approaching needle.
Symptoms from such mishaps known as SIRVA, for shoulder injury related to vaccine administration include chronic pain, limited range of motion, nerve damage, frozen shoulder and rotator cuff tear.
A third of the patients needed surgery, some of them twice.
There is no single way to treat shoulder injuries, regardless of how they occur. Treatments that work for some may not work for others.
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Types Of Pneumonia Vaccine
There are two vaccines which can provide protection against Streptococcus pneumoniae. They cannot prevent other types of bacterial pneumonia or any associated with a fungus or virus.
The two FDA-approved vaccines immunize a person against the specific serotypes that are most likely to cause illness and invasive disease. They are:
- PCV13, marketed under the name Prevnar 13,which prevents 13 of the most severe types of S. pneumoniae
- PPSV23, marketed under the name Pneumovax 23, which protects against an additional 23 S. pneumoniae serotypes
Neither vaccine is made from a live or whole bacteria but rather parts of the bacterial shell. While these components cannot cause disease, the immune system recognizes them as threats and triggers a defensive response in the same way it would to a real bacteria.
The PVC13 vaccine is delivered intramuscularly either into the deltoid muscle of the upper arm or the vastus lateralis muscle of the external thigh. The PPSV23 shot can either be given intramuscularly or subcutaneously .
Influenza And Pneumonia Vaccination For Adult Patients Undergoing Treatment For Cancer
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The Influenza Vaccine
The flu vaccine is aimed at protecting people who are most at risk from catching or spreading flu. As the strain of flu virus changes every year this means it is necessary to have the flu vaccine annually during the autumn or early winter. There are 2 different types of influenza vaccine recommended this year for adults by the Department of Health, both of which are inactivated vaccines . For those under the age of 65 the Quadrivalent Influenza Vaccine is recommended. For those over the age of 65 the Adjuvanted Trivalent Influenza Vaccine is recommended.
Should people who are having cancer treatment have a flu vaccine?
Yes. The Department of Health and Cancer Research UK recommend vaccination for people who are immunosuppressed because of disease or treatment. It is especially important this year, during the COVID-19 pandemic to have a flu vaccine. It is essential to be protected from flu as those who develop both flu and COVID together tend to be more unwell and are more likely to need to be admitted to hospital. If you are having, or have recently finished, cancer treatment you should ask about the vaccine.
Can the flu vaccines actually cause flu?
No. Most types of flu vaccination do not contain any live virus, so they cannot cause flu. However, you should not have the intra-nasal flu vaccine as this does contain live flu virus.
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Common And Local Adverse Events
Pneumococcal conjugate vaccine
Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38°C occurring in approximately 3% of vaccine recipients.
Pneumococcal polysaccharide vaccine
Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.
Who Should Have The Pneumococcal Vaccine
Anyone can get a pneumococcal infection. But some people are at higher risk of serious illness, so it’s recommended they’re given the pneumococcal vaccination on the NHS.
These include:
- babies
- adults aged 65 or over
- children and adults with certain long-term health conditions, such as a serious heart or kidney condition
Babies are offered 2 doses of pneumococcal vaccine, at 12 weeks and at 1 year of age.
People aged 65 and over only need a single pneumococcal vaccination. This vaccine is not given annually like the flu jab.
If you have a long-term health condition you may only need a single, one-off pneumococcal vaccination, or a vaccination every 5 years, depending on your underlying health problem.
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Problems That Could Happen After Getting Any Injected Vaccine
- People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your doctor if you or your child:
- Feel dizzy
- Have vision changes
- Have ringing in the ears
Before Taking This Medicine
You should not receive this vaccine if you ever had a severe allergic reaction to a pneumococcal vaccine.
Tell the vaccination provider if you or the child has:
-
heart problems
-
a weak immune system or
-
if you are receiving radiation or chemotherapy.
You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.
Tell the vaccination provider if you are pregnant or breastfeeding.
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Who Should Not Get The Vaccine
People should not get the vaccine if they have had a life threatening allergic reaction to a previous dose.
Additionally, a person should not undergo vaccination if they have had an allergic reaction to medication containing diphtheria toxoid or an earlier form of the pneumonia vaccination .
Lastly, people who are sick or have allergic reactions to any of the ingredients of the vaccine should talk to a doctor before getting the shot.
A pneumonia shot will not reduce pneumonia. However, it helps prevent invasive pneumococcal diseases, such as meningitis, endocarditis, empyema, and bacteremia, which is when bacteria enter the bloodstream.
Noninvasive pneumococcal disease includes sinusitis.
There are two types of pneumonia shots available. Which type a person gets depends on their age, whether or not they smoke, and the presence of any underlying medical conditions.
The two types are:
- Pneumococcal conjugate vaccine : Healthcare providers recommend this vaccine for young children, people with certain underlying conditions, and some people over the age of 65 years.
- Pneumococcal polysaccharide vaccine : Healthcare providers recommend this vaccine for anyone over 65 years of age, people with certain underlying conditions, and people who smoke.
According to the
- roughly 8 in 10 babies from invasive pneumococcal disease
- 45 in 100 adults 65 years or older against pneumococcal pneumonia
- 75 in 100 adults 65 years or older against invasive pneumococcal disease
Who Should Get The Vaccine
People over age 65. As you age, your immune system doesnât work as well as it once did. Youâre more likely to have trouble fighting off a pneumonia infection. All adults over age 65 should get the vaccine.
Those with weakened immune systems. Many diseases can cause your immune system to weaken, so itâs less able to fight off bugs like pneumonia.
If you have heart disease, diabetes, emphysema, asthma, or COPD , youâre more likely to have a weakened immune system, which makes you more likely to get pneumonia.
The same goes for people who receive chemotherapy, people who have had organ transplants, and people with HIV or AIDS.
People who smoke. If youâve smoked for a long time, you could have damage to the small hairs that line the insides of your lungs and help filter out germs. When theyâre damaged, they arenât as good at stopping those bad germs.
Heavy drinkers. If you drink too much alcohol, you may have a weakened immune system. Your white blood cells donât work as well as they do for people with a healthy immune system.
People getting over surgery or a severe illness. If you were in the hospital ICU and needed help breathing with a ventilator, youâre at risk of getting pneumonia. The same is true if youâve just had major surgery or if youâre healing from a serious injury. When your immune system is weak because of illness or injury or because itâs helping you get better from surgery, you canât fight off germs as well as you normally can.
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