Pneumococcal polysaccharide vaccine

Pneumococcal polysaccharide vaccine (PPSV)—known as Pneumovax 23 (PPV-23)—is the first pneumococcal 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 Streptococcus pneumoniae (pneumococcal) bacteria by phagocytic immune cells. The pneumococcal polysaccharide vaccine is widely used in high-risk adults.[2] As a result, there have been important reductions in the incidence, morbidity, and mortality from invasive pneumococcal disease.

Pneumococcal polysaccharide vaccine
Vaccine description
Target disease23 serotypes of Streptococcus pneumoniae
Typepolysaccharide
Clinical data
Trade namesPneumovax 23
AHFS/Drugs.comMonograph
MedlinePlusa607022
Pregnancy
category
    Routes of
    administration    		IM
    ATC code
    Legal status
    Legal status
    Identifiers
    ChemSpider
    • none
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    First used in 1945, the tetravalent vaccine was not widely distributed, since its deployment coincided with the discovery of penicillin.[3] In the 1970s, Robert Austrian championed the manufacture and distribution of a 14-valent PPSV.[4][5] This evolved in 1983, to a 23-valent formulation (PPSV23). A significant breakthrough affecting the burden of pneumococcal disease was the licensing of a protein conjugate heptavalent vaccine (PCV7) beginning in February 2000.[6]

    Medical uses

    In the United States, PPSV is recommended for adults 65 years of age or older, adults with serious long-term health problems, smokers, children older than two years with serious long-term health problems, giving the protection of five years or more.[7] The World Health Organization (WHO) recommendations are similar. The WHO does not recommend use of PPV in routine childhood immunization programs.[8] Pneumococcal vaccine is beneficial to control exacerbations of chronic obstructive pulmonary disease (COPD) and asthma.

    In March 2011, The Joint Committee on Vaccination and Immunisation (JCVI) of the United Kingdom advised those aged 65 years and older to stop using PPSV.[9] However, as of 2013, the Green Book, which is the United Kingdom's official government recommendations on immunizations, still carried the recommendation to give PPSV to those aged 65 and over.[10] PPSV should be offered to those in clinical risk groups.[9]

    PPSV is important for those with HIV/AIDS. 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.[2] Current WHO guidelines recommend immunization with PPV-23 for HIV patients in clinical stage 1, while the U.S. Centers for Disease Control and Prevention (CDC) recommends immunization in those with a CD4 cell count greater than 200/μL.

    Adverse events

    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.[11]

    Vaccination schedule

    Adults and children over two years of age

    The 23-valent vaccine (e.g., Pneumovax 23) is effective against 23 different pneumococcal capsular types (serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F), and so covers 90 percent of the types found in pneumococcal bloodstream infections.[12]

    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 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.[13]

    Special risk-groups
    Children at special risk (e.g. sickle cell disease and those without a functioning spleen) require additional protection using the 13-valent conjugated vaccine, with the more extensive 23-valent vaccine given after the second year of life:
    Vaccination schedule for children at special risk[10]
    Age2–6 months7–11 months12–23 months
    Conjugated vaccine3× monthly dose2× monthly dose2 doses, 2 months apart
    Further dose in second year of life
    23-valent vaccineThen after 2nd birthday single dose of 23-valent

    See also

    References
    1. Use During Pregnancy and Breastfeeding
    2. Siemieniuk RA, Gregson DB, Gill MJ (November 2011). "The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study". BMC Infectious Diseases. 11: 314. doi:10.1186/1471-2334-11-314. PMC 3226630. PMID 22078162.
    3. Macleod CM, Hodges RG, Heidelberger M, Bernhard WG (1945). "Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides". J Exp Med. 82 (6): 445–65. doi:10.1084/jem.82.6.445. PMC 2135567. PMID 19871511.
    4. Austrian R, Douglas RM, Schiffman G, et al. (1976). "Prevention of pneumococcal pneumonia by vaccination". Trans Assoc Am Physicians. 89: 184–94. PMID 14433.
    5. Klein, JO, Plotkin, SA (2007). "Robert Austrian: 1917-2007". Clin Infect Dis. 45: 2. doi:10.1086/520068.
    6. Kim NH, Lee J, Lee SJ, et al. (2007). "Immunogenicity and safety of pneumococcal 7-valent conjugate vaccine (diphtheria CRM(197) protein conjugate; Prevenar ) in Korean infants: differences that are found in Asian children". Vaccine. 25 (45): 7858–65. doi:10.1016/j.vaccine.2007.08.022. PMID 17931753.
    7. "Pneumococcal Vaccination - What You Should Know". Centers for Disease Control and Prevention (CDC). 6 December 2017. Archived from the original on 12 November 2019. Retrieved 11 November 2019.
    8. "World Health Organization. Pneumococcal vaccines". Archived from the original on 6 March 2002. Retrieved 29 May 2009.
    9. "JCVI issues preliminary advice on pneumococcal polysaccharide vaccination programme". National electronic Library for Medicines, NHS. 17 March 2011. Archived from the original on 2 October 2011.
    10. "Pneumococcal: the green book, chapter 25". Immunisation against infectious disease. Public Health England. 2013. Gateway 2017624. Archived from the original on 12 November 2019.
    11. Pneumococcal Polysaccharide Vaccine: What You Need to Know. US Centers for Disease Control and Prevention. 2009
    12. Pneumovax package insert Merck
    13. Childhood Pneumococcal Disease – information on the disease and the Prevnar vaccine, from the Victoria State (Australia) government. Includes possible side effects.

    Further reading
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