Background
Pneumococcal disease is caused by Streptococcus Pneumoniae (pneumococcus), a bacteria that can live in the nose and throat (nasopharynx) of healthy people and in most cases does not cause illness or disease. However, in some cases the bacteria may grow and spread to other parts of the body. Invasive pneumococcal disease (IPD) can manifest as meningitis, pneumonia, sinusitis, otitis media (ear infections), osteomyelitis (bone infection), joint infections and septicaemia (blood infection). The severity of illness can vary, with severe disease requiring hospitalisation, causing significant morbidity and even death. Certain individuals with specific medical conditions (advancing age, identifying as Aboriginal and Torres Strait Islander, Asplenia etc) may be considered at increased risk of IPD and therefore require additional protection.
Pneumococcal vaccines
There are currently two multivalent pneumococcal vaccines available for free on the National Immunisation Program (NIP).
- Prevenar 13® (13vPCV) – a conjugate vaccine, providing protection against 13 different serotypes of pneumococcal (1, 3, 4, 5, 6A, 7F, 9V, 14, 18C, 19A, 19F, 23F). It is available on the NIP for individuals >6 weeks of age.
- Pneumovax 23® (23vPPV) – a polysaccharide vaccine, providing protection against 23 serotypes of pneumococcal (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F and 33F). It is available on the NIP as an additional recommendation for individuals >4-years of age who are at increased risk of IPD (it is not recommended for those <2 years of age due to poor immunogenicity in this population).
Co-administration with other vaccines
13vPCV and 23vPPV may be co-administered with other vaccines on the NIP, including the quadrivalent influenza vaccine (QIV), live attenuated vaccines (MMR/Varicella/Zostavax®) and COVID-19 vaccines.
Consider where possible, different injection sites when co-administering pneumococcal and QIV in adults due to the increased risk of injection site reactions.
Common side effects of pneumococcal vaccines
- fever
- irritability
- lethargy
- pain at the injection site
- injection site reactions (redness, heat, swelling and tenderness)
- body aches
Note – In children, injection site reactions are more commonly reported as occurring within 24-48 hours following immunisation. In adults, injection site reactions may occur >3 days following the 13vPCV dose given at >70years, particularly in those who have previously received 23vPPV [see resources]. In both age groups a history of large local injection site reactions following previous pneumococcal vaccines is not a contraindication to further doses.
Current pneumococcal recommendations as of July 2020
Specific population groups are at an increased risk of IPD. Updated ATAGI advice relating to these population groups include:
- Children and adults with conditions that increase their risk from pneumococcal disease
- All Aboriginal and Torres Strait Islander older adults (age ≥50 years)
- All non-Indigenous older adults (age ≥70 years)
It is important for immunisation providers to familiarise themselves with the pneumococcal vaccine recommendations specific to each patient, recognising the variations to recommendations for different age groups, at-risk medical conditions, and Aboriginal and Torres Strait Islander status.
Table 1: Summary of pneumococcal vaccine recommendations for all age groups and risk-categories
| Age and risk category | Current age/Age at diagnosis of risk-condition | Prevenar 13® (13vPCV) schedule | Pneumovax 23® (23vPPV) schedule* |
|---|---|---|---|
| Infants and children with NO medical risk conditions (including Aboriginal and Torres Strait Islander children living in Vic, ACT, Tas and NSW) | < 12-months | As per NIP (2, 4 & 12-months)^ | N/A |
| Infants and children WITH a medical risk condition (including Aboriginal and Torres Strait Islander children) living in NT, QLD, SA and WA) | < 12-months | As per NIP (2, 4 & 12-months) + 1 additional dose at 6-months^ (total 4 doses in a lifetime) | Dose 1 at 4-years of age |
| Dose 2 ≥ 5-years following dose 1* | |||
| ≥ 12-months | As per NIP (2, 4 & 12-months) + 1 additional dose at age of diagnosis,^ given a minimum of 2-months after dose 3 (total 4 doses in a lifetime) | Dose 1 > 4-years of age (minimum 2- months after 4th dose of 13vPCV) | |
| Dose 2 ≥ 5-years after dose 1* | |||
| Aboriginal and Torres Strait Islander adults with NO risk condition | Adults > 50-years | 1 dose at > 50-years§ | 2 doses* at least 5-years apart (minimum of 2-months after dose of 13vPCV) |
| Non-indigenous adults with NO risk condition | Adults > 70-years | 1 dose at > 70-years#§
(catch up for all adults > 70-years) |
N/A |
| Non-indigenous adolescents/adults diagnosed with a risk condition | Any age | 1 dose at age of diagnosis# | 2 doses* at least 5-years apart (minimum of 2-months after dose of 13vPCV) |
*Maximum amount of 23vPPV in a lifetime is 2 doses
^ Refer to specific pneumococcal catch up advice if commencing immunisations late/delayed including Table. Catch-up schedule for 13vPCV for Aboriginal and Torres Strait Islander children living in NSW, Vic, Tas or ACT, and all children who do not have risk condition(s) for pneumococcal disease, aged <5 years and Table. Catch-up schedule for 13vPCV for Aboriginal and Torres Strait Islander children living in NT, Qld, SA or WA ONLY, and all children with risk condition(s) for pneumococcal disease, aged <5 years
§ For those individuals who have already received a dose 23vPPV, 13vPCV must be given ≥12-months after the 23vPPV
# In July 2020, 13vPCV replaced the 23vPPV that was previously funded at > 65-years. 13vPCV should still be given even if 23vPPV has been administered previously. In scenarios where 23vPPV was administered first, there should be a minimum interval of 12-months before giving 13vPCV
Resources
- Australian Immunisation Handbook: Pneumococcal disease
- Australian Immunisation Handbook: List. Risk conditions for pneumococcal disease
- ATAGI clinical advice on changes to recommendations for the use and funding of pneumococcal vaccines from 1 July 2020
- NCIRS: Pneumococcal vaccines- frequently asked questions
- Better Health Channel: Pneumococcal disease
- Human Vaccines and Immunotherapeutics: Coadministration of 13-valent pneumococcal conjugate and quadrivalent inactivated influenza vaccines in adults previously immunized with polysaccharide pneumococcal vaccine 23: a randomized clinical trial
Authors: Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (MVEC Education Nurse Coordinator), Teresa Lazzaro (Paediatrician, the Royal Children’s Hospital)
Reviewed by: Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Date: May 9, 2022
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.