pneumococcal vaccine

Pneumococcal Vaccine

The disease:

Pneumococcal disease is the term used to describe any infection caused by the bacterium Streptococcus pneumoniae (also known as ‘pneumococcus’). Pneumococcus has a capsule that protects it and helps it to cause infections. The composition of the capsule has been found to vary, which allows differentiation between different types of pneumococcus. There are over 90 different types of these bacteria. Some types can live in the nose and throat without making you sick but others are more invasive and can cause a number of infections and/or more serious diseases.

Pneumococcus is spread from person to person by inhaling the bacteria when someone carrying it coughs or sneezes, or by having direct contact with respiratory secretions of someone with the infection. The closer people are to each other, the higher the risk of transmission. Pneumococcal infection occurs most commonly in the winter months when respiratory diseases are more prevalent.

The time from the moment of exposure to the bacteria until the first symptoms of infection develop is not clearly defined but it may be as short as one to three days. Pneumococcal disease can range from ear and sinus infections to pneumonia (pneumococcus is in fact the most common cause of bacterial pneumonia in adults!), septicaemia (blood poisoning), and meningitis (inflammation of the membranes surrounding your brain and spinal cord), but it is known that some groups of people are more at risk of serious illness than others:

    1. The very young or the very old.
    2. People with chronic health conditions (disease of heart, lung, kidneys or liver).
    3. People with weakened immune systems.
    4. People with an absent or non-functioning spleen.
    5. Individuals with cerebrospinal fluid (CSF) leaks. CSF is a clear liquid that bathes the brain and spinal cord. If the tissue that holds CSF in around the brain and spinal cord has a small tear or hole, then CSF can leak out (particularly via the nose or ear).
    6. People with cochlear implants.
    7. People with skull defects or fractures.

The vaccine:

Pneumococcal vaccines are produced to protect against the types of pneumococcus that cause the most disease. Pneumococcal vaccines are administered by injection, do not contain any live bacteria and cannot cause pneumococcal disease.

There are two categories of pneumococcal vaccine available in the UK:

    • The pneumococcal ‘polysaccharide’ vaccine (PPV23), which is made using many small sugars from the surface of the bacteria and protects against 23 different types of pneumococcus (including those that are responsible for the majority of pneumococcal cases in the UK).
    • The pneumococcal ‘conjugate’ vaccines, which is made using the same small sugars but attached or ‘conjugated’ to something else that helps to generate a better response to the vaccine. The pneumococcal ‘conjugate’ vaccine (PCV13) is designed to protect against 13 different types of pneumococcus. However, it does not protect against 3 types of pneumococcus that are currently causing severe pneumococcal disease in the UK (and that are covered by the ‘polysaccharide’ vaccine).

The ‘polysaccharide’ vaccine is used to vaccinate older adults and persons with some chronic illnesses or weakened immune systems. Children younger than 2 years generally have a poor response to this vaccine and should rather be vaccinated with the ‘conjugate’ vaccine.

Overall, the ‘polysaccharide’ vaccine is 50 to 70% effective at preventing pneumococcal disease. It is therefore the best way we have to reduce your chances of getting pneumococcal infections and spreading them to others.

Like all vaccines in the UK, pneumococcal vaccines undergo a series of rigorous testing procedures before they become available to the public. Although pneumococcal vaccines are very safe, some mild and transient side effects can occur (mainly mild fever and/or soreness or swelling at the site of the injection).

Who should have the pneumococcal vaccine?

The ‘polysaccharide’ vaccine is recommended in the UK for people at high risk of pneumococcal disease (see above). Our recommendation is that all MSers aged 65 years and older receive the pneumococcal ‘polysaccharide’ vaccine. Also, regardless of age, we recommend that the ‘polysaccharide’ vaccine should be offered to all MSers who anticipate treatment with drugs that suppress their immune system and to those who are most disable. Highly disabled MSers, especially those with swallowing problems, are at risk of inhaling food, drink, vomit or saliva into their lungs. This can cause lung irritation that predisposes to pneumococcal lung infection (pneumonia). MSers who are already receiving drugs that suppress their immune system can also receive the pneumococcal ‘polysaccharide’ vaccine, however they may not respond as well to this vaccine.

MSers who are likely to have a severely compromised immune system (after haematopoietic stem cell transplantation, which is an intense chemotherapy treatment for MS) should receive the ‘conjugate’ followed by the ‘polysacharide’ vaccine at least 8 weeks later. In this way, the ‘conjugate’ vaccine will help to generate a better response to the ‘polysacharide’ vaccine.

Most MSers will only need a single pneumococcal vaccination, unless their spleen is not working properly or if they have chronic renal disease, where pneumococcal vaccination is recommended every five years.


Who should not have the pneumococcal vaccine?

Most MSers can have the pneumococcal vaccines. None of the pneumococcal vaccines should be given to MSers who have had a confirmed serious allergic reaction to the vaccine or any of its components in the past (which is very rare!).