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eferences 6 further reading 7 external links toggle the table of contents pneumococcal vaccine 24 languages العربية azərbaycanca català deutsch ελληνικά español français bahasa indonesia italiano 日本語 한국어 lietuvių മലയാളം bahasa melayu မြန်မာဘာသာ ଓଡ଼ିଆ português română српски srpski తెలుగు ไทย tiếng việt yorùbá 中文 edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia vaccine to prevent infection by the bacteria streptococcus pneumoniae pharmaceutical compound pneumococcal vaccine 23 valent pneumococcal polysaccharide vaccine by msd as it is marketed in japan vaccine description target streptococcus pneumoniae vaccine type conjugate polysaccharide clinical data ahfs drugs com monograph routes of administration intramuscular subcutaneous injection atc code j07al01 who j07al02 who j07al52 who legal status legal status us only in general prescription only identifiers chemspider none pneumococcal vaccines are subunit vaccines against the bacterium streptococcus pneumoniae 1 their use can prevent some cases of pneumonia meningitis and sepsis 1 there are two types of pneumococcal vaccines conjugate vaccines and polysaccharide vaccines 1 they are given by injection either into a muscle or just under the skin 1 the world health organization who recommends the use of the conjugate vaccine in the routine immunizations given to children 1 2 3 this includes those with hiv aids 1 the recommended three or four doses are between 71 and 93 effective at preventing severe pneumococcal disease 1 the polysaccharide vaccines while effective in healthy adults are not effective in children less than two years old or those with poor immune function 1 4 these vaccines are generally safe 1 with the conjugate vaccine about 10 of babies develop redness at the site of injection fever or change in sleep 1 severe allergies are very rare 1 whole cell vaccinations were developed alongside the characterisation of the subtypes of pneumococcus from the early 1900s 5 the first polysaccharide vaccine tetravalent was developed in 1945 6 the current 23 valent polysaccharide vaccine was developed in the 1980s 1 the first conjugate vaccine heptavalent reached market in 2000 7 it is on the world health organization s list of essential medicines 8 medical uses edit share of one year olds who received the final dose of pneumococcal vaccine different pneumococcal vaccines protect against different serotypes in particular their coverage of antibiotic resistant serotypes varies early vaccines did not cover certain serotypes which later became a major contributor to antibiotic resistant infections subsequent vaccines are designed to address this gap antibiotic resistant serotype coverage 9 10 vaccine rollout year resistant serotypes 6a 6b 9v 14 19a 19f 23f ppsv23 11 1983 no yes yes yes yes yes yes pcv13 12 2010 yes yes yes yes yes yes yes pcv20 2021 yes yes yes yes yes yes yes pcv15 2022 yes yes yes yes yes yes yes pcv21 2024 yes no no no yes no yes recommendations edit 13 valent pneumococcal conjugate vaccine prevnar 13 produced by pfizer japan in 2013 worldwide edit pneumococcal vaccines accelerated development and introduction plan pneumoadip is a program to accelerate the evaluation and access to new pneumococcal vaccines in the developing world pneumoadip is funded by the global alliance for vaccines and immunization gavi thirty gavi countries have expressed interest in participating by 2010 pneumoadip aims to save 5 4 million children by 2030 13 a pilot advance market commitment amc to develop a vaccine against pneumococcus was launched by gavi in june 2009 as a strategy to address two of the major policy challenges to vaccine introduction a lack of affordable vaccines on the market and insufficient commercial incentives to develop vaccines for diseases concentrated in developing countries under the terms of an amc donors make a legally binding guarantee that if a future vaccine is developed against a particular disease they will purchase a predetermined amount at an agreed upon price the guarantee is linked to safety and efficacy standards that the vaccine must meet and is structured to allow several firms to compete to develop and produce the best possible new product amcs reduce risk to donor governments by eliminating the need to fund individual research and development projects that may never produce a vaccine if no company produces a vaccine that meets the predetermined standards governments and thus their taxpayers spend nothing for the bio pharmaceutical industry amcs create a guaranteed market with a promise of returns that would not normally exist for developing countries amcs provide funding to ensure that those vaccines will be affordable once they have been developed it is estimated that the pneumococcal amc could prevent more than 1 5 million childhood deaths by 2020 14 independent source needed doctors without borders has criticized gavi s pneumococcal amc for not encouraging innovation discouraging competition from new market entrants and raising vaccine costs they said that it had allowed pfizer and glaxosmithkline to maintain a duopoly while making it more difficult for the serum institute of india to sell their cheaper vaccine the duopoly allowed price discrimination somewhat higher prices for gavi and unaffordable prices about ten time the gavi price for middle income countries too rich for gavi aid 15 the pneumococcal program unlike previous market shaping programs from gavi 16 independent source needed did not include any mechanism for increasing competition 17 the humanitarian mechanism makes the pneumococcal vaccine available to humanitarian actors but not governments at a lower than normal price during humanitarian emergencies 18 belgium edit the national vaccination program started vaccinating newborns in 2004 with the 7 valent pneumococcal conjugate vaccine pcv 7 this was changed into the 13 valent conjugate pcv 13 in 2011 the switch to the 10 valent conjugate pcv 10 was made in july 2015 in flanders and may 2016 in wallonia 19 in late 2020 a start was made with the vaccination of care home residents with the 23 valant pneumococcal polysaccharide vaccine ppv 23 20 canada edit the public health agency of canada s general recommendations are the 13 valent pneumococcal conjugate vaccine pcv 13 vaccine for children aged 2 months to 18 years and the 23 valent pneumococcal polysaccharide vaccine ppv 23 vaccine for adults 21 india edit in may 2017 the government of india decided to include the pneumococcal conjugate vaccine in its universal immunization programme 22 the netherlands edit the national vaccination program started including the pneumococcal vaccine for newborns in april 2006 23 the health council advised in 2018 that those who are over the age of 60 should also be vaccinated on a 5 year recurring schedule the resulting program nppv started at the end of 2020 24 health authorities reported in december 2020 that former covid 19 patients also have an indication for this vaccine because of the damage their lungs incurred vaccinating this group is not part of the nppv program 25 new zealand edit the national immunisation schedule first introduced pneumococcal vaccination in 2006 starting with pcv7 for high risk individuals 26 as of december 2022 the schedule now includes three doses of pcv13 for all infants given at 6 weeks 5 months and 12 months of age 27 a high risk schedule including a fourth dose is offered for infants with an eligible medical condition with the additional dose given at 3 months of age ppv23 is not included in the routine immunisation schedule but is funded for adults and children over 2 years of age at increased risk of invasive pneumococcal disease 28 south africa edit the 7 and 13 valent pneumococcal conjugate vaccines pcv7 and pcv13 were introduced into the national expanded program on immunization epi in south africa in 2009 and 2011 respectively south africa became the first african country and the first nation in the world with a high hiv prevalence to introduce pcv7 into its routine immunization program 29 rates of invasive pneumococcal disease ipd including cases caused by antibiotic resistant bacteria have fallen substantially in south africa following the introduction of pcv7 among children under two years of age the overall incidence of ipd declined nearly 70 after pcv introduction and rates of ipd caused by bacteria specifically targeted by the vaccine decreased nearly 90 30 due to the indirect protection conferred by herd immunity a significant decline in ipd in children and in unvaccinated adults has also been shown 30 pneumovax 23 is used for all ages and according to the enclosed patient information leaflet has a reported 76 to 92 protective efficacy pneumococcal types 1 2 3 4 5 6b 7f 8 9n 9v 10a 11a 12f 14 15b 17f 18c 19a 19f 20 22f 23f and 33f are included where indicates drug resistant pneumococcal infections these are the 23 most prevalent or invasive pneumococcal types of streptococcus pneumoniae medical citation needed united kingdom edit it was announced in february 2006 that the uk government would introduce vaccination with the conjugate vaccine in children aged 2 4 and 13 months 31 32 this included changes to the immunisation programme in general 33 in 2009 the european medicines agency approved the use of a 10 valent pneumococcal conjugate vaccine for use in europe 34 the 13 valent pneumococcal vaccine was introduced in the routine immunization schedule of the uk in april 2010 citation needed united states edit diagram with visual representation of the current indications for both the prevnar and the pneumovax 35 in the united states a heptavalent pneumococcal conjugate vaccine pcv 7 prevnar was recommended for all children aged 2 23 months and for at risk children aged 24 59 months in 2000 the normal four dose series is given at 2 4 6 and 12 14 months of age in february 2010 a pneumococcal conjugate vaccine that protects against an additional six serotypes was introduced pcv 13 brand name prevnar 13 and can be given instead of the original prevnar 36 37 in june 2021 a pneumococcal conjugate vaccine which protects against 20 serotypes was approved with the brand name prevnar 20 38 in april 2023 the fda approved the use of prevnar 20 vaccine to prevent pneumococcal disease in children aged six weeks to 17 years 39 40 41 pneumovax 23 pneumococcal vaccine polyvalent was approved for medical use in the united states in 1983 42 43 vaxneuvance pneumococcal 15 valent conjugate vaccine was approved for medical use in the united states in june 2021 44 45 capvaxive pneumococcal 21 valent conjugate vaccine was approved for medical use in the united states in june 2024 46 47 in october 2024 the centers for disease control and prevention cdc updated its recommendations for the pneumococcal vaccination and recommends routine pneumococcal vaccination for all children younger than 5 years of age and all adults 50 years of age or older 48 49 mechanism edit polysaccharide vaccine edit the pneumococcal polysaccharide vaccine most commonly used today citation needed consists of purified polysaccharides from 23 serotypes 1 2 3 4 5 6b 7f 8 9n 9v 10a 11a 12f 14 15b 17f 18c 19a 19f 20 22f 23f and 33f 50 immunity is induced primarily through stimulation of b cells which release igm 50 without the assistance of t cells 51 this immune response is less robust than the response provoked by conjugated vaccines which has several consequences the vaccine is ineffective in children less than 2 years old presumably due to their less mature immune systems 50 non response is also common amongst older adults 50 immunity is not lifelong so individuals must be re vaccinated at age 65 if their initial vaccination was given at age 60 or younger 50 since no mucosal immunity is provoked the vaccine does not affect carrier rates promote herd immunity or protect against upper or lower respiratory tract infections 50 finally provoking immune responses using unconjugated polysaccharides from the capsules of other bacteria such as h influenzae has proven significantly more difficult 50 conjugated vaccine edit the pneumococcal conjugate vaccine pcv consists of capsular polysaccharides covalently bound to the diphtheria toxoid crm197 which is highly immunogenic but non toxic 50 this combination provokes a significantly more robust immune response by recruiting crm197 specific type 2 helper t cells which allow for immunoglobulin type switching to produce non igm immunoglobulin and production of memory b cells 50 among other things this results in mucosal immunity and the eventual establishment of lifelong immunity after several exposures 50 for targeted serotypes the pcv reduces colonization rates and provides herd immunity it also appears to reduce the development of antimicrobial resistance among targeted serotypes 50 the main drawbacks of conjugated vaccines are that they only protect against a subset of the serotypes covered by the polysaccharide vaccines medical citation needed research edit due to the geographic distribution of pneumococcal serotypes additional research is needed to find the most efficacious vaccine for developing world populations in a previous study the most common pneumococcal serotypes or groups from developed countries were found to be in descending order 14 6 19 18 9 23 7 4 1 and 15 in developing countries the order was 6 14 8 5 1 19 9 23 18 15 and 7 52 in order to further pneumococcal vaccine research and reduce childhood mortality five countries and the bill melinda gates foundation established a pilot advance market commitment for pneumococcal vaccines worth us 1 5 billion advance market commitments are a new approach to public health funding designed to stimulate the development and manufacture of vaccines for developing countries 53 there is research into producing vaccines that can be given into the nose rather than by injection 54 55 the development of serotype specific anticapsular monoclonal antibodies has also been researched in recent years these antibodies have been shown to prolong survival in a mouse model of pneumococcal infection characterized by a reduction in bacterial loads and a suppression of the host inflammatory response 56 57 additional pneumococcal vaccine research is taking place to find a vaccine that offers broad protection against pneumococcal disease 58 as of 2017 update pneumonia vaccines target up to 23 forms of the bacterium that cause pneumonia with a new version under development covering 72 strains of the bacterium 59 needs update nonspecific effects edit a 2004 study reports that pcv reduces rates of ...