Pneumococci are the cause of around 25 to 40% of all community-acquired pneumonia and up to 12,000 deaths per year in Germany. It is estimated that more than 800,000 children under the age of six die of pneumococcal infections worldwide each year.
The pneumococcal vaccination is paid for by the statutory health insurance in Germany and has been recommended since 2006. The Standing Vaccination Commission (STIKO) at the Robert Koch Institute has published the following vaccination recommendations in the Epidemiological Bulletin :
Basic immunization for children up to 2 years of age
Vaccination against pneumococci is recommended for all children up to their second birthday. For this purpose, there are two conjugate vaccines for children from two months to five years with an interval of 8 weeks (2 + 1 scheme), which meanwhile cover 10 or 13 pneumococcal serotypes (PCV10 or PCV13). Since polysaccharide vaccines only achieve an adequate immune response from around two years of age, this is only approved from the second birthday. An exception to the 2 + 1 scheme are premature babies (born before the 37th week of gestation): From the age of 2 months, they receive 3 vaccine doses every 4 weeks (3 + 1 scheme).
In all cases, the primary vaccination should be completed at the age of 11-14 months (and with a minimum interval of 6 months from the previous vaccination) with a last dose.
Infants aged 13–24 months who have not yet been vaccinated receive only two doses of vaccine at least 8 weeks apart as a catch-up vaccination.
Indication vaccinations for risk groups
For people with an increased health risk for severe pneumococcal diseases (risk groups), vaccination against pneumococci is recommended regardless of age.
- In patients with congenital or acquired immunodeficiencies or immunosuppression, such as B .:
- T cell deficiency or impaired T cell function
- B-cell or antibody deficiency (e.g. hypogammaglobulinaemia )
- Deficiency or dysfunction of myeloid cells (e.g. neutropenia , chronic granulomatosis , leukocyte adhesion defects, signal transduction defects)
- Complement or proper indeficiency
- functional hyposplenism (e.g. sickle cell anemia ), splenectomy, or anatomical asplenia
- in cancer
- HIV infection
- after bone marrow transplant
- immunosuppressive therapy (e.g. for organ transplantation or autoimmune disease )
- Immunodeficiency in chronic kidney failure, nephrotic syndrome or chronic liver failure
- In patients with other chronic diseases, such as B .:
- In patients with anatomical and foreign body-associated risks for pneumococcal meningitis, such as: B .:
- Liquor fistula
- Cochlear implant
In June 2019, the Federal Ministry of Labor and Social Affairs announced the occupational health rule (AMR) 6.7 “Pneumococcal vaccination as part of preventive occupational health care for activities involving hazardous substances by welding and cutting metals ”. This AMR deals with the vaccination to protect against pneumococcal diseases, which are favored by working with hazardous substances by welding and cutting metals ( welding smoke exposure ).
Standard vaccination for adults over 60 years
All people aged 60 and over who do not belong to a risk group (see above) should receive a single vaccination with the 23-valent polysaccharide vaccine (PPSV23). This is a polysaccharide vaccine ( Pneumovax , a polyvalent capsular polysaccharide) to be administered subcutaneously or intramuscularly , which covers 23 of the most common (of over 80 known) pneumococcal serotypes .
Since both pneumococcal vaccines do not cover all of the approximately 90 pathogenic pneumococcal serotypes, they do not offer complete protection against infections, but the 23-valent vaccine covers about 90 percent of the serotypes typically responsible for pneumococcal diseases, namely pneumococcal serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F.
There are also two conjugate vaccines approved in Germany, one against 10 serotypes (used from 6 weeks of age to 4 years of age) and one against 13 serotypes (used from 6 weeks of age). The 10-valent conjugate vaccine covers the pneumococcal serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F, the 13-valent the serotypes 1, 3, 4, 5, 6A, 6B, 7F , 9V, 14, 18C, 19A, 19F and 23F. In them, the capsular polysaccharides are coupled to the CRM197 carrier protein (an immunogenic but non-pathogenic part of the diphtheria toxoid ) and adsorbed on aluminum orthophosphate . In the case of the polysaccharide vaccine, the B cells are activated, but no memory cells are built up. In the conjugate vaccine, the T cells are also stimulated so that an immunological memory can be built up; in addition, the mucosal protection increases through the release of secretory antibodies.
Vaccination (like the disease itself) does not produce lifelong immunity. The immunity of the conjugate vaccines can be boosted by the polysaccharide vaccine and expanded by the 15 additional serotypes. A second vaccination with the 23-valent vaccine is not recommended due to increasing local reactions and decreasing protective effect despite repetition. The vaccination should only be repeated every five years in people with congenital or acquired immunodeficiencies, patients with chronic kidney disease and in people who have had a spleen removed.
One advantage of vaccination over treatment with antibiotics is that vaccination protects against the serotypes covered by the vaccine, even if they are already resistant to antibiotics . In addition, the vaccination has a preventive effect, i.e. it prevents the disease - in contrast to the therapeutic approach of antibiotics. In the USA, following the general introduction of vaccination, there has been a decrease in the number of pneumococcal infections as well as a reduced rate of penicillin-resistant pneumococci.
Due to the synergistic effects of the pneumococci and the influenza virus and the similar risk profile of the sick, it is recommended to supplement the pneumococcal protection with an annual flu vaccination .
A meta-analysis published in 2009 found no conclusive evidence that vaccination with the polysaccharide vaccine reduced the pneumonia rate and mortality. Protection against invasive pneumococcal disease was evident in otherwise healthy adults, but not in the chronically ill.
In some countries, an increase in pneumococcal disease from the non-vaccinated serotypes has been noted.
Conjugate vaccines are well tolerated by infants and young children. The undesirable effects that may occur are comparable to those of other typical vaccinations. In combination with hexavalent combination vaccines (DTPa-HB-IPV / Hib), an increased rate of fever (over 39 ° C) has been observed.
The vaccine is contraindicated for acute illnesses and known allergic reactions to components of the vaccine.
- Information from the RKI on pneumococcal pneumonia
- Information from the RKI on pneumococcal vaccination
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- Justification of the STIKO recommendations for vaccination against pneumococci and meningococci from July 2006 . In: Epidemiological Bulletin . 30, August 2006, pp. 255-270.
- Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 326 f. ( Pneumococcal vaccination ).
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- Federal Institute for Occupational Safety and Health (Ed.): AMR 6.7 "Pneumococcal vaccination as part of preventive occupational health care for activities involving hazardous substances by welding and cutting metals" . S. 7 .
- Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 327
- Erika Mutius, Monika Gappa, Ernst Eber, Urs Frey: Pediatric Pneumology . Springer-Verlag, 2014, ISBN 978-3-642-34827-3 , pp. 436 .
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