About the Pneumococcal Vaccines Two pneumococcal vaccines, known as polysaccharide vaccines, are commercially available. These vaccines are called Pnu-Imune®23 (Wyeth Ayerst) and Pneumovax®23 (Merck & Co., Inc.). Immunity to one pneumococcal serotype does not offer immunity to a different serotype. Therefore, Pnu-Imune 23 and Pneumovax 23 consist of a mixture of the capsular sugars of the 23 serotypes of pneumococci which are most common in the United States. For the vaccines to be effective, the mixture of serotypes in the vaccine must correspond to the naturally circulating pneumococcal serotypes. The Centers for Disease Control and Prevention in Atlanta, Georgia maintains active surveillance of the serotypes of pneumococci obtained from patients with blood stream or central nervous system infections. The current vaccines contain about 87 percent of the serotypes causing invasive disease in the United States. About 2-3 weeks after receiving the pneumococcal vaccine, the recipient develops antibodies to many or all of the 23 pneumococcal serotypes in the vaccine. Antibody levels may be lower in elderly persons, in persons with depressed immune systems, and in some persons with chronic medical conditions such as alcoholic cirrhosis or insulin dependent diabetes mellitus. Unfortunately, Pnu-Imune 23 and Pneumovax 23 cannot be used in children below 2 years of age because this age group does not respond to polysaccharide vaccines. Other types of vaccines, among them being the "conjugate pneumococcal vaccines" are being developed and tested for use in young children. Efficacy of Pneumococcal Vaccine Several studies have shown that the current polysaccharide vaccines are effective in reducing invasive pneumococcal disease by about 56 to 81 percent. However the current polysaccharide vaccines have not been shown to be of value in preventing pneumococcal otitis media. Most episodes of pneumococcal otitis media occur in children under two years of age and at a time when the current vaccines cannot be given. The question of whether pneumococcal polysaccharide vaccines prevent pneumococcal pneumonia is still unresolved. In early studies pneumococcal polysaccharide vaccine was shown to be highly effective in preventing cases of pneumococcal pneumonia in a population with a very high incidence of pneumococcal infections (South African gold miners). Later studies in the United States have not shown that receipt of the vaccine consistently prevents cases of pneumonia. However, public health officials and most U. S. physicians recommend using the pneumococcal polysaccharide vaccines because of the strong evidence that it protects against the most serious forms of pneumococcal infection, that is, invasive disease.
	Who Should Receive Pneumococcal Vaccine Immunization recommendations may change from year to year. Therefore please consult with your health care provider and the latest Advisory Committee on Immunization Practices recommendations published in the Morbidity and Mortality Weekly Report (MMWR) for up-to-date information. The MMWR can be accessed by clicking on the CDC web site. Pneumococcal vaccine is recommended for all persons above the age of 2 years who are at increased risk of pneumococcal disease or its complications. These groups are as follows: Persons at or above 65 years of age. All persons in this group should receive pneumococcal vaccine including those who had received an earlier dose of vaccine when they were under 65 years as long as 5 years has elapsed since their first dose. All persons in this age group with unknown vaccination status should receive one dose of vaccine. Persons aged 2-64 years with chronic illness. Persons at increased risk include those with chronic heart or lung disease, alcoholism, diabetes and cirrhosis. Persons 2-64 years of age without spleens or who have diseases of the spleen. Persons who have had their spleens removed or who have abnormally functioning spleens are at high risk from invasive pneumococcal disease and they should receive a dose of pneumococcal vaccine. Persons 2-64 years of age who live in special environments. Persons living in nursing homes or in other long term facilities should be immunized. Immunocompromised persons. Persons with depressed immune function are at particular risk from invasive pneumococcal disease. Therefore the vaccine is recommended for persons with HIV infection, lymphatic cancers and persons receiving corticosteroids or other immunosuppressive therapy. Patients with HIV infection should receive pneumococcal vaccine as soon as possible.
	Revaccination (booster doses) with Pneumococcal Vaccine Revaccination is recommended for persons above 2 years of age who are at the highest risk for invasive pneumococcal infection and who are likely to have a rapid decline in antibody levels. These include: Children above 2 years and adults with absent or diseased spleens.* Persons with renal failure, dialysis or kidney transplantation.* Immunocompromised persons.* Persons at or above age 65 years who received their first dose of pneumococcal vaccine more than 5 years before and were less than 65 years of age at the time of their first dose (Figure 9). *Revaccination is recommended 5 years after the first vaccination if the person is over 10 years old, otherwise revaccination is recommended 3 years after the first vaccination. How the Vaccine is Given A small amount (7-8 drops) of pneumococcal vaccine is administered with a sterile needle into the muscle, or under the skin, of the upper arm. The vaccine may also be given in the side of the thigh, although it is not usually given in this area. Side Effects from the Vaccine Pneumococcal vaccine is considered to be a very safe vaccine. Mild local reactions, for example soreness and/or redness at the site of the injection, occur in about half of persons receiving the vaccine. These reactions subside after 24-48 hours. Severe generalized reactions are rare and no deaths have ever been causally related to receipt of pneumococcal vaccine. Pneumococcal vaccine can be safely given at the same time that other vaccines, such as tetanus toxoid and influenza, are given. Pneumococcal vaccine is a killed vaccine, that is, it does not contain live agents, therefore it cannot cause pneumococcal disease. Precautions Children less than 2 years of age should not receive the polysaccharide vaccine because the polysaccharide vaccines are not effective in this age group. The safety of pneumococcal polysaccharide vaccine during the first trimester (first three months) of pregnancy has not been evaluated, although no adverse consequences have been reported among newborns whose mothers were inadvertently vaccinated during pregnancy.