Pneumococcus Vaccine

The Standing Committee on Vaccination (STIKO) recommends that all adults over the age of 65 should be vaccinated. The vaccine PPSV23 should be used, as it protects against 23 of a total of more than 90 serotypes. A general booster is not recommended for healthy persons and should be decided on a case-by-case basis by the attending physician.

However, for the above-mentioned persons with an increased risk of severe pneumococcal disease, a booster is recommended after at least six years (STIKO with reference to the technical information on PPSV23). If a booster is given before the 6-year period has elapsed, considerable side effects are to be expected.

For immunocompromised patients and for patients with chronic diseases such as asthma, COPD, emphysema, seizure disorders, cerebral palsy and diabetes mellitus, an initial sequential vaccination with PCV13 is recommended. Only after 6 to 12 months, vaccination with PPSV23 should then be given.

The following vaccines are available according to the Rober Koch Institute (as of October 2017):

• a 10-valent conjugate vaccine (PCV10, Synflorix®), licensed from 6 weeks to 59 months of age.
• a 13-valent conjugate vaccine (PCV13, Prevenar 13®), licensed from 6 weeks of age, with no upper age limit
• a 23-valent polysaccharide vaccine (PPSV23, Pneumovax® 23), licensed from 2 years of age, without upper age limit.

In principle, sequential vaccination with a conjugate vaccine (possibly better immunogenicity for this indication) followed by PPSV23 (broader serotype coverage) is recommended for individuals with asplenia. This recommendation is based on immunological considerations. Meaningful studies with clinical endpoints demonstrating a superior protective effect by sequential vaccination are lacking to date. For immunological reasons, sequential vaccination should be carried out first with PCV13 or PCV10 and 6-12 months later with PPSV23 (minimum interval 2 months).

The specific procedure depends on the age of the patient:

• Children <24 months should be primed with conjugate vaccine (PCV10 or PCV13), like all children:
• Age <12 months: 3 doses of vaccine.
• Age 12 to <24 months: 2 doses of vaccine.
• PPSV23 is not recommended or licensed in this age group because of insufficient immunogenicity.
• Children 2 years of age and older, adolescents, and adults who have not been vaccinated against pneumococcal disease or who have previously been vaccinated only with PCV7 should be vaccinated sequentially with 1 dose of PCV13 followed by PPSV23 at 6-12 months.
• Unvaccinated children under 6 years of age may receive 2 doses of PCV10 at a minimum of 2 months apart instead of 1 dose of PCV13.
• Individuals who have already been prevaccinated with PPSV23 should not be vaccinated with PCV13 until at least 1 year later. Revaccination with PPSV23 should be given 6 years after the last PPSV23 vaccination, but no earlier than 6 months after the PCV13 vaccination.
• Repeat vaccinations: The duration of vaccine protection is limited. Therefore, repeat vaccinations are recommended at 6-year intervals. For this purpose, only PPSV23 should be used because of its broader serotype coverage. If the minimum interval of 6 years is observed, a serious decrease in immunogenicity (so-called hyporesponsiveness) or tolerability of the vaccination is not to be expected. Only few data are available on the question of whether multiple repeat vaccinations are useful. In principle, it seems plausible to refresh the vaccination protection approx. every 6 years.

1. Communication of the Robert Koch Institute (retrieved on 25.1.2021).