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• Measles, Mumps, and Rubella
• Varicella-Zoster Virus (Chickenpox)
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• Pneumococcal Pneumonia
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Immunizations

Description

An in-depth report on the purpose of immunizations and recommended schedules.

Alternative Names

Measles; Rubella; Tetanus; Vaccinations; Whooping cough

Pneumococcal Pneumonia

The pneumococcal bacterium (also called Streptococcus pneumoniae or S. pneumoniae ) is responsible for many respiratory infections in the upper and lower airways. This bacterium is dangerous for people with serious underlying chronic medical conditions and illnesses and is the leading cause of ear infections and sinusitis in children. The most serious complication is pneumonia.

About 1.2 million people are hospitalized each year for pneumonia, which is the third most frequent reason for hospitalizations. (Births are first and heart disease is second.) Although the majority of pneumonias respond well to treatment, the infection can still be a very serious problem. It kills between 40,000 and 70,000 people each year. Together with influenza, pneumonia is the sixth leading cause of death in the US and is the leading cause of death from infection.

Of particular concern is the increasing prevalence of pneumococcal bacteria that are resistant to many standard antibiotics. This has created a great sense of urgency in the medical community to find effective measures for preventing infection.

Vaccine Description

The pneumococcal vaccine protects against S. pneumoniae (also called pneumococcal) bacteria, the most common cause of respiratory infections. There are two effective vaccines available: The 23-valent polysaccharide vaccine (Pneumovax, Pnu-Immune) for adults and the 7-valent conjugate vaccine Prevnar (PCV7) for infants and young children. Experts are now recommending that more people, including healthy elderly people, be given the pneumococcal vaccine, particularly in light of the increase in antibiotic-resistant bacteria. There is a great sense of urgency in the medical community to find effective measures for preventing infection.

Candidates for the Pneumococcal Vaccine

The 7-valent conjugate vaccine Prevnar (PCV7) is very effective in children. Evidence suggests that this vaccination, plus the vaccination against H. influenzae (an important cause of meningitis), has led to 30,000 fewer cases of serious bacterial infections each year.

The pneumococcal vaccine is now recommended by many experts for the following groups:

• Children up to age 2 years. Prevnar has now been added to the Recommended Childhood Immunization Schedule. The vaccine is very effective in children. Studies are suggesting that it prevents common ear infections as well as serious infections, such as pneumonia. In one study, a similar vaccine under investigation protected not only children in day care from serious respiratory infections, but their younger unvaccinated siblings had fewer infections as well.
• Children up to age 5 who are at risk for pneumonia or complications of influenza, such as children with sickle disease, those with immune deficiencies, or children with chronic medical conditions.
• Other children ages 2 - 5 to five who are higher risk for serious pneumococcal infections should be considered for vaccinations. They include African or Native Americans, children in group child care, socially or economically disadvantaged children, or those who have had frequent or complicated acute middle ear infections within the past year. (In one study, the vaccine reduced the number of ear infections episodes by 6%.)

Pneumococcal Vaccine in Older Children and Adults. The vaccine is proving to be effective in reducing the rate of pneumonia in young adults, although not to the degree that it protects young children. The benefit for the elderly -- other than protection against bloodstream infection -- is unclear. Still, pneumonia is declining among adults, which may be due to fewer infections being transmitted from vaccinated young children. Many experts now recommend the vaccine for the following older children or adults:

• All people over 65 years old. Some experts believe that all adults between 50 and 64 should also be vaccinated. Unfortunately, although the vaccination is protective against pneumococcal bacteremia (invasive infection) in people over 65, evidence suggests that it does not appear to protect against community-acquired pneumoniae.
• Adults with any chronic condition that increases the risk for pneumonia. This includes patients with heart disease (such as congestive heart failure), chronic lung disease (COPD or emphysema, but not asthma), or diabetes.
• Individuals with immune deficiencies (such as HIV) or those undergoing treatments that suppress the immune system.
• Patients with autoimmune diseases, such as rheumatoid arthritis and lupus. Unfortunately, studies show the vaccine may not be as effective in these patients as those with healthy immune systems. Nevertheless they are at high risk for serious respiratory infections and should be vaccinated.
• Patients with kidney disease or kidney transplants. Older people who have had transplant operations or those with kidney disease may require a revaccination after 6 years.
• Patients with problems in the spleen.
• Alcoholics, especially those with cirrhosis.
• People living in long-term care facilities.
• Alaska Natives or American Indians, who may be at increased risk for pneumonia.

Because the vaccine is inactive, it is safe for pregnant women and people with immune deficiencies. In fact, when the vaccine is administered to pregnant women, it may actually protect their infants against certain respiratory infections.

Protection lasts for over 6 years in most people, although the protective value may be lost at a faster rate in elderly people than in younger adults. Anyone at risk for serious pneumonia should be revaccinated 6 years after the first dose, including those who were vaccinated before age 65. Subsequent booster doses, however, are not recommended.

Typical Immunization Schedule

The recommended schedule of immunization for Prevnar (PCV7) is 4 doses, given at 2, 4, 6, and 12 to 15 months of age. Infants starting immunization between 7 and 11 months should have 3 doses. Children starting their vaccinations between 12 and 23 months only need 2 doses. Those who are over 2 years old need only one dose.

Side Effects of the Pneumococcal Pneumonia Vaccine

Side effects include pain and redness at the injection site, fever, and joint aches. Children are more likely to have fever within 48 hours if they receive other vaccines at the same time and also after the second dose. Rarely, such local reactions can be severe. Among severe reactions, about 38% involve neurological complications; others include seizures and death. Fortunately, severe reactions are very rare, even if a person is mistakenly re-vaccinated before the effects of the first vaccination have worn off. Allergic reactions are also very rare.

• Review Date: 2/14/2007
• Reviewed By: A.D.A.M. Editorial: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy; previously reviewed by Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (8/23/2006).

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