Pneumococcal vaccine

Pneumococcal vaccination is against the main causative agent of infectious, bacterial pneumonia, protect the pneumococci. The pneumococcus is responsible for about 25 to 40 % of all community-acquired pneumonia and up to 12 000 deaths a year in Germany. Worldwide die annually estimated more than 800,000 children under six years of pneumococcal infections.

Vaccination in adults and chronically ill

Vaccination is of the permanent Committee on Vaccination (STIKO ) at the Robert Koch Institute, all people over 60 years, and beyond for immunocompromised patients, but also for chronic diseases such as cardiovascular disease, asthma, COPD, kidney disease or chronic neurological diseases such as seizure disorders or cerebral palsy sufferer persons recommended and paid for by the statutory health insurance. For this purpose there is a polysaccharide vaccine ( Pneumovax ®), which covers 23 pneumococcal serotypes, however, is permitted only from the second birthday because polysaccharide vaccines achieve until about two years an adequate immune response. Since 2011, a conjugate vaccine ( Prevenar13 ®) is approved for adults that covers 13 serotypes.

Vaccination in children

Recommendations STIKO

Since the summer of 2006, the pneumococcal vaccination for all children up to the second birthday - and not, as previously only in preterm infants or debilitated babies - recommended and also paid by the statutory health insurance. There is a conjugate vaccine for children aged two months to five years, covering seven pneumococcal serotypes (PCV 7) for this purpose.

Compatibility and combinations

Studies are available for the simultaneous administration of hexavalent combination vaccine Infanrix ® hexa ( DTPa-HB-IPV/Hib ) and PCV7. The combined administration does not reduce the immunogenicity of PCV7, but increased compared with the sole administration of Infanrix ® hexa the incidence of side effects, especially fever partly about 38.5 ° C. Interactions and tolerability of the combination with other hexavalent vaccines has not been adequately studied.

Effect

Since both vaccines do not cover all of the approximately 90 pathogenic Pneumokokkenserotypen, they do not provide complete protection against infection, but the 23- valent vaccine covers about 80 % of the charge of typically for pneumococcal serotypes from related diseases.

Since the distribution of serotypes differs somewhat in infancy, the 7- valent vaccine covers 50 to 80 % of the charge at this age for pneumococcal disease serotypes. The 23- valent polysaccharide vaccine covers the pneumococcal serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F from. The 7- valent conjugate vaccine covers the pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. With him the capsular polysaccharides are coupled to the CRM197 protein carrier ( an immunogenic but nonpathogenic part of the diphtheria toxoid ) and adsorbed on aluminum orthophosphate.

Vaccination (as well as the disease itself) does not produce lifelong immunity. The immunity of conjugate vaccines can be boosters by the Polysacchardidimpfstoff and expand the 15 additional sero- types. A second vaccination with the 23-valent vaccine is not recommended because of repetition, despite growing local reactions and decreasing protective effect. Only in individuals with congenital or acquired immunodeficiencies, patients with chronic kidney disease and in humans after splenectomy, vaccination should be repeated every 5 years.

One advantage of the vaccination to treatment with antibiotics is that vaccination also protects against serotypes covered by the vaccine if they are already resistant to antibiotics. In addition, vaccination has a preventive effect, that is, it prevents the disease - in contrast to the therapeutic approach of antibiotics. In the U.S., after the general introduction of vaccination in addition to a decrease in the number of pneumococcal infections also shown a decreased rate of penicillin - resistant pneumococci.

Due to the synergistic effects of the pneumococcus and the influenza virus and a similar risk profile of the patients is recommended to supplement the pneumococcal protection through an annual flu vaccination.

A meta-analysis published in 2009 found no conclusive evidence that vaccination with the polysaccharide vaccine decrease the pneumonia rate and mortality. The protection against invasive pneumococcal disease was significantly in otherwise healthy adults, but not among the chronically ill.

In some countries, an increase of pneumococcal disease by unvaccinated serotypes was observed.