Pneumococcal Infections and Vaccination
What are the dangers of Pneumococcal infection in childhood?
Pneumococcal bacterial disease is a droplet infection of the respiratory tract easily caught by small children, people with reduced immunity and the elderly. It is the main cause of meningitis in children under 5 years. In the United Kingdom pneumococcal infection is responsible for 50 deaths a year from serious infections which include meningitis, septicaemia, bacteraemia and pneumonia. One infant in six who has pneumococcal meningitis dies. Many of the survivors are left with brain damage, epilepsy and deafness.
Unlike Meningococcal meningitis (routine Meningitis C vaccination already protects against this) which has a diagnostic bruise like rash readily confirmed by the ‘glass test’, there is no warning rash with pneumococcal infection. The child can quickly become seriously ill before the significance of the infection is realised by parent or doctor.
Which children are vaccinated on the NHS for pneumococcal infections?
A vaccination programme for all infants is currently available. Infants under one year receive two injections with a booster shortly after the first birthday.
Which vaccines are used?
WellCare uses Prevenar™ (made by Wyeth) to vaccinate infants from the age of 2 months to 5 years. For children over 5 years and adults WellCare uses Pneumovax11™ (made by MSD) Both Prevenar ™ and Pneumovax11™ are used by the DoH.
Does either vaccine contain mercury and is either of the vaccines live?
Prevenar™ and Pneumovax11™ do not contain thiomersal (mercury). Both vaccines are inactivated, this means they do not contain live organisms and cannot cause the diseases against which they protect.
How effective is Prevenar™ in preventing pneumococcal infections?
In clinical trials Prevenar™ is between 69% and 97% effective. This immunity is remembered and should last through adult life.
How effective is Pneumovax11™?
85 to 95% develop antibodies to all 23 strains of pneumococci protecting 50 to 70% from pneumococcal infection. However, immunity may decline as soon as three to five years after vaccination and more rapidly in children.
Why is WellCare recommending the use of Prevenar™ instead of the cheaper Pneumovax11™ for the over two’s?
Prevenar has the advantage over Pneumovax11™ in that the body’s immune system ‘remembers’ previous vaccination with it and any subsequent vaccination with Prevenar™ boosts the previous immunity leading to long term immunity to the pneumococcus. Prevenar™ is the only pneumococcal vaccine licensed for children under 2 years of age and is licensed for use up to the age of 5 years giving permanent protection against the seven strains mainly found in children.
In contrast Pneumovax11™ vaccine only gives short term immunity but to 23 strains found in adults and children. A follow on dose does not give a cumulative boost to the previous immunity and is not recommended. The use of Pneumovax11™ is reserved for adults or children with special risk factors for pneumococcal disease. These are sickle cell disease, congenital and acquired splenic dysfunction, HIV infection, malignancy, chronic illness or if immunocompromised.
In Summary : Prevenar™ protects long term against the seven strains of pneumococcus found mainly in children. Second doses or boosters to Prevenar give cumulative added long term protection. Pneumovax11™ protects short term against 23 strains of pneumococcus and repeat dosing does not raise the immunity.
Pneumococcal Vaccination schedule
The NHS will vaccinate normal risk children with Prevenar at 2 months and again at 4 months, with a booster of Prevenar early after the child's first birthday.
WellCare will use the following schedule based on current DoH thinking.
Prevenar for children over 2 months and under 5 years
(7 valent pneumococcal polysaccharide conjugated vaccine) |
Start age
2 - 11 months |
2 vaccinations at 8 week intervals 1 booster early after first birthday (and at least two months after the 2nd vaccination)
|
Start age
12 - 23 months |
2 vaccinations at 8 weekly intervals
No booster required |
Start age
2 years -
5 years |
Only 1 vaccination is required |
Prevenar is not available for children over 5 years. Although Pneumovax11 is available to children over the age of 2 years, WellCare recommends that Prevenar is used as it protects long term against the seven strains of pneumococcus found mainly in children. Pneumovax11 protects short term against 23 strains of pneumococcus covering strains found in adults and children (please see Pneumococcal Infections and Vaccination - Your Questions Answered for more information about this). |
