Pneumococcal vaccination

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This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

A pneumococcal vaccination can protect against the main pathogen causing infectious bacterial pneumonia , the pneumococci .

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.

STIKO recommendations

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 anatomical and foreign body-associated risks for pneumococcal meningitis, such as: B .:

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 .

effect

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.

The pneumococcal vaccination is not effective against infection of the CSF space through trauma-related direct inoculation of the pathogen.

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.

compatibility

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.

Web links

Individual evidence

  1. ^ Katherine L. O'Brien et al .: Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates . In: Lancet (London, England) . tape 374 , no. 9693 , September 12, 2009, p. 893-902 , doi : 10.1016 / S0140-6736 (09) 61204-6 , PMID 19748398 .
  2. ↑ Justification of the STIKO recommendations for vaccination against pneumococci and meningococci from July 2006 . In: Epidemiological Bulletin . 30, August 2006, pp. 255-270.
  3. ^ A b 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 ).
  4. ↑ Recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute. (PDF) In: Epidemiological Bulletin No. 34/2019. Robert Koch Institute , August 22, 2019, pp. 328–329; 322–323 , accessed April 20, 2020 .
  5. ↑ a b V. Seifert: Pneumococcal infections - which vaccine for which patients? ( Allgemeinearzt-online.de [accessed November 30, 2018]).
  6. ↑ 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 .
  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
  8. ↑ Erika Mutius, Monika Gappa, Ernst Eber, Urs Frey: Pediatric Pneumology . Springer-Verlag, 2014, ISBN 978-3-642-34827-3 , pp. 436 .
  9. ↑ PEI list of approved vaccines against pneumococci. Retrieved November 30, 2018 .
  10. ↑ RKI - vaccinations A - Z - vaccination against pneumococci: Frequently asked questions and answers. Retrieved November 30, 2018 .
  11. ↑ Synflorix | European Medicines Agency. Retrieved November 30, 2018 .
  12. ^ Prevenar 13 | European Medicines Agency. Retrieved November 30, 2018 .
  13. ↑ Marianne Abele-Horn (2009), p. 327.
  14. ^ B. Christenson et al .: Additive preventive effect of influenza and pneumococcal vaccines in elderly persons . In: The European Respiratory Journal . tape 23 , no. 3 , March 2004, p. 363-368 , doi : 10.1183 / 09031936.04.00063504 , PMID 15065822 .
  15. ↑ a b Anke Huss et al .: Efficacy of pneumococcal vaccination in adults: a meta-analysis . In: CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne . tape 180 , no. 1 , January 6, 2009, p. 48-58 , doi : 10.1503 / cmaj.080734 , PMID 19124790 , PMC 2612051 (free full text).
  16. ↑ SA Moberley et al .: Vaccines for preventing pneumococcal infection in adults . In: The Cochrane Database of Systematic Reviews . No. 1 , January 23, 2008, p. CD000422 , doi : 10.1002 / 14651858.CD000422.pub2 , PMID 18253977 .
  17. ↑ MASS VACCINATION WITH PREVENAR - FIRST DATA FROM EUROPE. In: Medicinal Telegram. March 6, 2009, accessed April 20, 2020 .
  18. ↑ a b Erika Mutius, Monika Gappa, Ernst Eber, Urs Frey: Pediatric Pneumology . Springer-Verlag, 2014, ISBN 978-3-642-34827-3 , pp. 437 .