Pneumococcal disease is caused by Streptococcus pneumoniae bacteria and is a leading cause of pneumonia, meningitis, and sepsis worldwide. Pneumonia kills nearly 1 million children under five each year, with pneumococcus being the leading cause. While immunization has prevented millions of child deaths each year, 1.5 million children still die from vaccine-preventable diseases like pneumonia. The introduction of pneumococcal conjugate vaccines (PCV) has reduced rates of invasive pneumococcal disease in vaccinated children as well as indirectly in unvaccinated people through herd immunity effects. PCV provides advantages over polysaccharide vaccines by eliciting an immune memory response and longer-lasting protection against more pneumococcal serotypes

3. By

4.  Pneumococcal disease is caused by Streptococcus pneumoniae, one
of the most important causes of morbidity and mortality in adults and
children throughout the world.
 According to the World Health Organization, pneumococcus is
responsible for approximately 1.6 million deaths every year, of which
nearly 1 million deaths are in children aged <5 years, mostly in
developing countries.

8.  Pneumococcal disease is the leading bacterial cause of pneumonia in
children and also causes meningitis and septicemia.
 About 90 percent of pneumococcal deaths are due to pneumonia .

10. Pneumonia kills nearly 1 million children under five and pneumococcal disease is
the leading cause of pneumonia.

13. Nearly 30 percent of annual childhood deaths worldwide
are vaccine-preventable

14. Immunisation has been one of the great success stories of global
health.
It is estimated to prevent the deaths of two to three million
children each year.
But another 1.5 million children still die from diseases that could be
prevented by routine vaccines

16.  The World Health Organisation estimates that 1.5 million
children under five die each year from diseases that could be
prevented by routine immunisation.
 The eradication of smallpox in 1980 helped encourage global
efforts to fight more diseases through immunisation.

22. Streptococcus pneumoniae, also called
pneumococcus, was first isolated by
Pasteur in 1881 from the saliva of a
patient with rabies.
Streptococcus pneumoniae bacteria are
lancet-shaped, gram-positive, facultative
anaerobic organisms.
They are typically observed in pairs
(diplococci) but may also occur singularly
or in short chains

24.  S. pneumoniae is a Gram-positive bacterium with a polysaccharide
capsule, which is a virulence factor.
 More than 90 polysaccharide serotypes have been identified, with each
serotype eliciting serotype specific immune responses.
 Different serotypes vary in their propensity for nasopharyngeal
colonisation and for causing disease.

25.  Pneumococci are common inhabitants of the respiratory tract and
may be isolated from the nasopharynx of asymptomatic human
carriers , There is no animal or insect vector.
 Many people, especially children, have the pneumococci in their
nostrils, pharynx, or throats without manifesting signs
or symptoms of ill health or developing invasive disease ,
this is called asymptomatic carriage .

26.  S. pneumoniae colonize the upper respiratory tract in 5–10% of
healthy adults and 20–40% of healthy children.
 Carriage of pneumococci in the nasopharynx varies with age and
environmental factors. The duration of carriage is generally
longer in children.
 All pneumococcal disease presumably begins with naso -
pharyngeal colonisation .

29. Transmission
 Transmission of pneumococci occurs via respiratory droplets
from individuals with nasopharyngeal colonisation.
 Transmission of S. pneumoniae occurs as the result of direct
person-to-person contact via respiratory droplets and by
autoinoculation in persons carrying the bacteria in their upper
respiratory tract.

31. Pneumococcal colonisation
 Pneumococcal disease may take place when two situations
coincide:
1. The host is colonized with a pneumococcal strain against which
immunity has not yet been established .
2. An alteration of the natural barriers or host immune system has
occurred.

32.  After colonization in the nasopharynx, infection of nearby sites
may develop.
 Alternatively, infection might also be caused by direct aspiration
into the bronchial tree causing pneumonia or by hematogenous
invasion leading to bacteremia, meningitis, or infection of other
distant organs .

36. Clinical Syndromes of pneumococcal disease
* Acute otitis media
WHO. Acute Respiratory Infections (Update September 2009). 2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable
Diseases. The Pink Book. 11th Edition. May 2009.

38. Invasive Pneumococcal Disease in Children
1. Bacteremia without a known site of infection is the most common
invasive clinical presentation of pneumococcal infection among children
2 years of age and younger, accounting for approximately 70% of
invasive disease in this age group.
2. Bacteremic pneumonia accounts for 12%–16% of invasive pneumococcal
disease among children 2 years of age and younger.
3. With the decline of invasive Hib disease, S. pneumoniae has become the
leading cause of bacterial meningitis among children younger than 5
years of age in the United States.

39.  In young children, bacteraemia accounts for 50 to 70% of all
episodes of IPD, followed by pneumonia (15 to 25%) and meningitis
(4%).
 In adults, bacteraemic pneumonia accounts for 50 to 80% of
all episodes of IPD.

40. Non-invasive disease
 Acute otitis media and pneumonia (without bacteraemia) are
classified as non-invasive disease for surveillance purposes.
 Pneumococcal pneumonia is the most common clinical
presentation of pneumococcal disease among adults.
 Pneumococcus is estimated to account for over a third of all
community-acquired pneumonia in adults.

41.  Pneumococcal pneumonia can occur in combination with
bacteremia and/or meningitis, or it can occur alone.
 Isolated pneumococcal pneumonia is not considered invasive
disease but it can be severe.
 Pneumococcal bacteremia occurs in about 25%–30% of patients
with pneumococcal pneumonia.

44.  Middle ear infections are the most frequent reasons for pediatric
office visits in the United States, resulting in more than 20
million visits annually.
 Complications of pneumococcal otitis media may include
mastoiditis and meningitis.

46. Pneumonia
1 in 20
deaths
Bacteremia
1 in 5
deaths
Meningitis
3 in 10
deaths
Clinical Syndromes –case fatality Rates

47.  Different pneumococcal serotypes have different propensities for
causing asymptomatic colonization, otitis media, pneumonia ,
Bacteremia and meningitis .
 Not all pneumococcal serotypes are equally able to cause disease
.
 Most serotypes cause disease, but only a few produce the
majority of invasive pneumococcal disease , The 10 most common
types cause 62% of invasive disease worldwide.

48.  Anyone can get pneumococcal disease, but some people are at
greater risk for disease than others.
 Being at extremes of age or having some medical conditions OR
immunocompomised can put you at increased risk for
pneumococcal disease.

49. Everybody Is at Risk

51. The Very Young ≥65 Adults

52. Underlying Conditions
Long-Term Health Problems Weakened Immune System
Heart or lung disease, sickle cell, diabetes,
alcoholism, cirrhosis, leaks of cerebrospinal
fluid, cochlear implant
Hodgkin’s lymphoma, leukemia, kidney failure,
multiple myeloma, nephrotic syndrome, HIV or
AIDS, damaged or no spleen, organ transplant

53. Smokers Asthma Sufferers

55. Conditions That Increase Risk for Invasive Pneumococcal Disease

58. Most successful medical intervention ever developed
for prevention of infectious disease
IMMUNIZATION

63. Pneumococcal polysaccharide vaccine (PPSV23 or
Pneumovax23®)
 The first polysaccharide pneumococcal vaccine was licensed in the
United States in 1977.
 It contained purified capsular polysaccharide antigen from 14
different types of pneumococcal bacteria.
 In 1983, a 23-valent polysaccharide vaccine (PPSV23) was licensed
and replaced the 14-valent vaccine, which is no longer produced.

68. Pneumococcal conjugate vaccine
 In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in
the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C,
19F, and 23F) of Streptococcus pneumoniae and became known as
PCV7 (Prevnar by Wyeth, now Pfizer).
 Ten years later in February 2010, a new 13-valent product was licensed
— PCV13 (Prevnar 13, Pfizer) — which added 6 new serotypes (1, 3, 5,
6A, 7F, and 19A).
 In February 2010 ACIP recommended that healthcare providers
transition from use of PCV7 to use of PCV13 for routine vaccination of
children.

73. Prevenar 13 (PCV13)
23F19F18C149V6B4
19A7F6A531
1.Prevenar EPAR. 2. Prevenar 13 Summary of Product Characteristics March 2012. 3. Centers for Disease Control
and Prevention. Update: Haemophilus influenzae type b vaccine. MMWR. 1989;38:14.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00001330.html. Accessed May 24, 2011.
Using CRM197 , the same carrier protein as Prevenar 1,2,
with more than 20 years of experience in vaccines 3

74. 74
Description of PCV vaccines
4, 6B, 9V, 14, 18C, 19F, 23F
PCV 13 (Prevenar13) 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F
CRM197 Diphtheria carrier protein
CRM197 Diphtheria carrier protein
PCV 7 (Prevenar)
3, 6A, 19A
NTHi protein D
4, 6B, 9V, 14, 23F, 18C, 19F 1, 5, 7F
NTHi protein DTT DT
PCV 10 (Synflorix)

77. PCV has two brand names, what are their differences?
A) Prevenar 13 has 13 serotypes while Synflorix has 10
serotypes (Or to simply put it, Prevnar 13 offers additional 3
points protection versus Synflorix.)
B) Prevenar 13 is recommended by CDC (Center for Disease
Control ) while Synflorix is recommended by European Medicine
Agency.
C) Prevenar 13 is more expensive than Synflorix.

78. Pneumococcal serotype Vaccine
PPSV23 PCV13 PCV7
4 X X X
6B X X X
9V X X X
14 X X X
18C X X X
19F X X X
23F X X X
1 X X
3 X X
5 X X
6A X
7F X X
19A X X
2 X
8 X
9N X
10A X
11A X
12F X
15B X
17F X
20 X
22F X
33F X
The 13-valent pneumococcal
conjugate vaccine (PCV13)
includes the seven serotypes in
the 7-valent vaccine (PCV7)
and six additional serotypes.
The 23-valent pneumococcal
polysaccharide vaccine
(PPSV23) includes 12 of the
serotypes included in PCV13 (it
does not include serotype 6A)
and 11 additional serotypes.

79. (PCV13) (PPSV23)

81.  The other major difference between PPSV23 and PCV13 is the
design of the vaccine itself.
 PPSV23 contains capsular polysaccharide antigens. These
antigens elicit a T-cell independent antibody response.
 PCV13 is a conjugate vaccine that combines these capsular
polysaccharides with a protein carrier. With the addition of the
protein, PCV13 produces a T-cell dependent immune response with
antibody production and the potential for immune memory.

82. Pneumococcal conjugate vaccine

83. Polysaccharide
antigens
Immunogenic
carrier protein
Conjugate
vaccine
A polysaccharide (ps) is chemically linked (conjugated) to a protein carrier 1
+ =

84. + =
Conjugate vaccine
The conjugation of a polysaccharide to a carrier protein leads to the interaction with T cells
resulting in the release of functional antibodies and production of memory B cells 1,2
Polysaccharide
antigens
Immunogenic
carrier protein
B cell
Plasma cell
T-independent
Presentation
T cell B cell
Memory B cell
T-dependent
Plasma cell

85. Advantage of Pneumococcal conjugate vaccine

86. Polysaccharide Vs Conjugate vaccine

87.  Children under 2 years of age have an immature immune system
that cannot produce memory cells to the polysaccharide capsule,
therefore PPSV23 vaccines is not effective in this age group.
 PCV13: Pneumococcal conjugate vaccine is similar to PPSV23, but
the capsular polysaccharide is joined to a protein that will induce
memory cells even in children <2years of age.

88.  Polysaccharide vaccines only elicit a B-cell response, so although
antibodies are produced, there is no long-term memory .
 Repeated doses do not seem to be beneficial, and may result in
lower antibody concentrations than those after primary
immunization , so-called “hypo-responsiveness” .
 For Polysaccharide vaccines , The levels of antibodies specific for
the different serotypes substantially declined 5-10 years after
vaccination.

89.  The lack of a T-cell response with polysaccharide vaccines has
been overcome by conjugation to protein carriers .This invokes
a T-cell response, resulting in antibodies and immune memory
 Polysaccharide conjugate vaccines have several advantages
over plain polysaccharide vaccines:
 Induction of higher antibody concentrations for a longer time; high
immunogenicity in young children
 Repeated doses boost the immune response without causing
hypo-responsiveness.

91. The “herd effect”

98. Studies that have shown a dramatic decrease in the number of
pneumococcal infections since the introduction of pneumococcal vaccination
into the childhood vaccination programme.

100.  Pneumococcal conjugate vaccines have decreased the rates
of IPD directly in vaccinated children and indirectly (herd
protection) in unvaccinated persons
 The “herd effect” that can result in a significant decline in
pneumococcal disease due to serotypes contained in the vaccine in
individuals who do not receive the vaccine
 Thus, vaccination has exponential benefits to the community by
preventing transmission to people who are potentially vulnerable to
infection.

101.  Deployment of pneumococcal conjugate vaccines (PCV) has had
clear public health benefits:
1. The incidence of invasive pneumococcal disease has been
reduced not only in vaccinated children, but also in elderly adults,
who benefit from herd immunity
2. Hospital admissions for community-acquired pneumonia among
children less than two years old have been reduced &
the incidence of acute otitis media in healthy vaccinated children
has decreased.
 In 2007, the WHO recommended the use of pneumococcal
conjugate vaccines in all countries.

103. Will PCV13 Protect 100% against Pneumonia?
 The answer is no. This vaccination can only reduce the risk of
developing pneumonia. Out of 90 strains, Pneumococcal 13 can
protect against 13 of the most aggressive serotypes causing
serious infection in children.
 In other words, any strain not covered by the PCV13 still has the
possibility to infect and cause pneumonia, otitis media etc.
Moreover, the causes of pneumonia are also not limited to
Streptococcus pneumoniae, it can also be caused by other
bacteria, viruses and mycoplasmas.
 In addition to the pneumococcal vaccine, Hib vaccine, influenza
vaccine, measles, chicken pox and pertussis vaccine can also be
taken to reduce the risk of pneumonia in children.

104.  My patient has had laboratory-confirmed pneumococcal pneumonia.
Does he/she still need to be vaccinated with PCV13 and/or
PPSV23?
 Yes. There are more than 90 known serotypes of pneumococcus (13
serotypes in the conjugate vaccine and 23 serotypes in the
polysaccharide vaccine).
 Infection with one serotype does not necessarily produce immunity to
other serotypes. As a result, if the person is a candidate for
vaccination, s/he should receive it even after one or more
episodes of invasive pneumococcal disease.

107. Different types of pneumococcal vaccine?
Yes, Let's classify them according to ages when they're given.
1. For babies (less than 24 months)
Pneumococcal Conjugate Vaccine (PCV) is sold as Prevenar 13 and
Synflorix.
It is given starting 2 months old.
Prevenar 13 is made by Wyeth while Synflorix is made by Glaxo -
SmithKline.
 2. For kids and adults(24 months and above)
Pneumococcal Polysaccharide Vaccine (PPSV) is sold as Pneumo 23 or
Pneumovax
It is given starting 24 months old onwards to adulthood.
Pneumo 23 is made by Sanofi Pasteur & Pneumovax is made by Merck .

108. Road Map

111.  PCV7 was initially recommended for routine use in infants and
children ages 2 through 59 months.
 The recommendations were expanded with the licensure
of PCV13 (In February 2010 ACIP recommended transition from
use of PCV7 to use of PCV13 for routine vaccination of
children) to include vaccination of children age 60 through
71 months with underlying medical conditions .
 Also recommendations to consider vaccination of older children,
ages 6 through 18 years, with medical conditions placing them at
increased risk of invasive pneumococcal disease.

114.  What are the recommendations for routinely administering
PCV13 to children?
 All children younger than 2 years old should be routinely vaccinated
with pneumococcal conjugate vaccine .
 Give infants a primary series of pneumococcal conjugate vaccine
(PCV13, Prevnar 13, Pfizer) at age 2, 4, and 6 months. Boost at age 12
through 15 months.
 Children who fall behind should be given catch-up vaccination

115.  What are the recommendations for routinely
administering PCV13 to children?
 For catch-up vaccination, give PCV13 to healthy children
through age 59 months and give PCV13 to children through age
71 months who have certain underlying medical conditions.
 ACIP does not recommend routine PCV13 vaccination of
healthy children 60 months of age or older.

116. Catch–up vaccination with PCV13:
 Unvaccinated children 7 months of age and older do not require
a full series of four doses. The number of doses a child needs to
complete the series depends on the child’s current age.
 Unvaccinated children aged 12 through 23 months should
receive two doses of vaccine, at least 8 weeks apart.

117. Catch–up vaccination with PCV13:
 Catch-up vaccination is recommended for children younger than
age 5 years who did not receive vaccine on schedule.
 Administer 1 dose of PCV13 to all healthy children aged 24
through 59 months who are not completely vaccinated for their
age.
 Routine use of PCV13 is not recommended for healthy children
aged ≥5 years.

120.  Previously unvaccinated healthy children 24 through 59 months
of age should receive a single dose of PCV13.
 Unvaccinated children 24 through 71 months of age with certain
chronic medical conditions should receive 2 doses of
PCV13 separated by at least 8 weeks.

123.  A single dose of PCV13 may be administered for children 6
through 18 years of age who have not received PCV13
previously and are at increased risk for invasive pneumococcal
disease because of :
1) Anatomic or functional asplenia ( including sickle cell disease) .
2) Immunocompromising conditions such as HIV-infection .
3) Cochlear implant, or cerebrospinal fluid leaks .

125. 
Summary of PCV13 Vaccine Recommendations by
Age Group (CDC Nov 22, 2016 )
Infants and Children younger than 2 Years Old
 PCV13 is routinely given to infants as a series of 4 doses, one dose
at each of these ages: 2 months, 4 months, 6 months, and 12
through 15 months.
 Children who miss their shots or start the series later should still
get the vaccine. The number of doses recommended and the
intervals between doses will depend on the child's age when
vaccination begins.

126. Children 2 through 5 Years
 Healthy children 24 months through 5 years of age who are
unvaccinated or have not completed the PCV13 series for their age
should get 1dose of PCV13.
 ACIP does not recommend routine PCV13 vaccination of healthy
children 60 months of age or older
 Children 24 months through 5 years of age with certain medical
conditions should get 1 or 2 doses of PCV13 if they have not
already completed the 4-dose series.

127. For children aged 2 through 5 years with any of following conditions:

128. For previous groups
 Administer 1 dose of PCV13 if any incomplete schedule of 3
doses of PCV13 was received previously.
 Administer 2 doses of PCV13 at least 8 weeks apart if
unvaccinated or any incomplete schedule of fewer than
3 doses of PCV13 was received previously.
 The minimum interval between doses of PCV13 is 8 weeks.

129.  A single dose of PCV13 may be administered for
PCV13-naïve children age 6 through 18 years who are :
 1. Candidate for or recipient of cochlear implant
2. Cerebrospinal fluid (CSF) leak
3. Functional or anatomic asplenia (e.g., sickle cell disease,
splenectomy)
4. Immunocompromising conditions (e.g., HIV infection, leukemia,
congenital immunodeficiency, Hodgkin’s disease, lymphoma, multiple
myeloma, generalized malignancy, immunosuppressive therapy)
5. Solid organ transplantation; for bone marrow transplantation
6. Chronic renal failure or nephrotic syndrome

132. Vaccine Recommendations (PPSV23)
 The vaccine is indicated for persons 2 years of age and older with a
normal immune system who have a chronic illness, including
cardiovascular disease, pulmonary disease, diabetes, alcoholism,
cirrhosis, cerebrospinal fluid leak, or a cochlear implant.
 Immunocompromised persons , or with functional or anatomic
asplenia 2 years of age and older who are at increased risk of
pneumococcal disease or its complications should also be
vaccinated.
 PPSV is not given routinely to healthy children.

133. Summary of PPSV23 Vaccine Recommendations by
Age Group
 Anyone 2 through 18 years of age who has one of the following chronic
medical conditions should get only 1 dose of PPSV23:
 Chronic heart disease, (particularly cyanotic congenital heart
disease and cardiac failure)
 Chronic lung diseases, including asthma if treated with high-dose
oral corticosteroid therapy)
 Diabetes mellitus
 Alcoholism
 Chronic liver disease
 Cerebrospinal fluid leaks
 Cochlear implant(s)

134.  Anyone 2 through 18 years of age who has one of the following
immunocompromising conditions should get 2 doses of PPSV23, 5
years apart:
 Functional or anatomic asplenia
 Congenital or acquired immunodeficiencies
 HIV infection
 Leukemia or lymphoma
 Hodgkin disease
 Generalized malignancy
 Iatrogenic immunosuppression (diseases requiring treatment with
immunosuppressive drugs, including long-term systemic corticosteroids and radiation
therapy)
 Solid organ transplant
 Multiple myeloma
 Chronic renal failure or nephrotic syndrome

137.  Following vaccination with PPSV23, antibody levels decline after 5–
10 years and decrease more rapidly in some groups than others.
 Currently available pneumococcal polysaccharide vaccines elicit a
T-cell-independent response, and do not produce a sustained
increase (“boost”) in antibody titers.
 Because of the lack of evidence of improved protection with
multiple doses of pneumococcal vaccine, routine revaccination of
immunocompetent persons previously vaccinated with 23-valent
polysaccharide vaccine is not recommended.

143.  How should we administer both pneumococcal vaccines
(PCV13 and PPSV23) to our high risk pediatric patients?
 All children with risk factors for pneumococcal disease or its
complications should be vaccinated with PPSV23 beginning at age 2
years.
 If they are age-eligible and are due for a dose of PCV13, give that
one first and then wait 8 weeks before giving PPSV23.

145. What is the schedule?
 PCV is given 3 primary shots and one booster shot starting
at 2 months old.
 Primary shots can be given as early as 2,4,6 months. It can
also be given 1 month apart. Booster shot can be given
before 15 months.
 Catch up immunization should be given if vaccine schedule is
missed.

146. Children 2 through 5 Years
 Healthy children 24 months through 5 years of age who are
unvaccinated or have not completed the PCV13 series for their
age should get 1dose of PCV13.
 ACIP does not recommend routine PCV13 vaccination of
healthy children 60 months of age or older
 Children 24 months through 5 years of age with certain medical
conditions should get 1 or 2 doses of PCV13 if they have not
already completed the 4-dose series or unvaccinated.

147.  Children 6 through 18 years of age with certain medical
conditions (Cochlear implant, or cerebrospinal fluid leaks ,
Anatomic or functional asplenia &Immunocompromising
conditions ) should get 1 dose of PCV13 if they have not
previously received this vaccine (PCV13-naïve children ) .
 Revaccination after an age-appropriate primary series with
PCV13 is not currently recommended.

148.  Vaccination with PPSV23 is recommended for children aged
2–18 years with the following underlying medical conditions
after completing all recommended PCV13 doses :
(those with a normal immune system who have a chronic illness,
including cardiovascular disease, pulmonary disease, diabetes,
alcoholism, cirrhosis, cerebrospinal fluid leak, or a cochlear
implant& Immunocompromising conditions).
 PPSV23 is given at 24 months old then it can be boosted after
5 years only in Immunocompromised persons and those with
functional or anatomic asplenia .

151.  A 2-month-old was mistakenly given PPSV23 instead of
PCV13. What should be done?
 PPSV23 is not effective in children less than 24 months of age.
PPSV23 given at this age should not be considered to
be part of the pneumococcal vaccination series.
 PCV13 should be administered as soon as the error is
discovered.

153. Storage and Handling
 Both pneumococcal conjugate &pneumococcal polysaccharide
vaccines should be refrigerated at temperatures between
2°C to 8°C (35°F to 46°F ).
 Do not freeze either vaccine. Vaccine exposed
to freezing temperature should not be administered.

154. Visual Inspection
 Shake vigorously prior to use to obtain a homogenous, white
suspension in the vaccine container
 Prior to administration, visually inspect the vaccine for
particulate matter and/or discoloration. If these conditions exist,
do NOT use

155. Route, Site of administration
 Pneumococcal polysaccharide vaccine may be administered
intramuscularly or subcutaneously, while pneumococcal
conjugate vaccine is administered intramuscularly.
 The preferred site for infants and young children is the vastus
lateralis muscle in the anterolateral thigh.
 The preferred injection site in older children and adults is the
deltoid muscle.

157. Toddlers (1-2 years)

159. No Immunizations Back Here

160. Who should NOT receive pneumococcal vaccine?
 For both PPSV and PCV13, people who had a severe allergic
reaction to one dose should not receive another (such reactions
are rare).
 People who have a moderate or severe acute illness should wait
until their condition improves to be vaccinated.

161. Can the vaccine cause pneumococcal disease?
 No. The vaccines cannot cause pneumococcal disease Both
PPSV and PCV13 are inactivated vaccines containing only
a portion of the bacteria.

162. How safe are the pneumococcal vaccines?
 PPSV and PCV13 are both very safe vaccines. No serious reactions
have been associated with either PPSV or PCV13.
 For PPSV, about 30%–50% of the people who get the vaccine have very
mild side effects, such as redness or pain where the shot was given.
Fewer than 1% of recipients develop a fever, muscle aches, or more
severe local reactions.
 For PCV13 about 1 out of 3 children have swelling where the shot was
given, about 1 of 3 have a mild fever, about 1 in 20 have a higher fever
(over 102oF), and about 8 out of 10 become fussy or irritable.
About half of the children were drowsy after the shot or
had a temporary loss of appetite.

163. Can both pneumococcal vaccines be given at the same
office visit?
 Pneumococcal conjugate and polysaccharide vaccines should
never be administered during the same visit.
 If a patient needs both vaccines, you should administer a dose
of pneumococcal conjugate vaccine (PCV13) first, followed by a
dose of pneumococcal polysaccharide vaccine
(PPSV23) at another visit.
 PPSV and PCV13 should be separated by at least 8 weeks.

164. Administration with Other Vaccines
 PCV13 has been administered concurrently with vaccines containing
the following antigens with no adverse effects on immunogenicity or
safety : diphtheria, tetanus, acellular pertussis, Haemophilus
influenzae type b, rotavirus, rubella, hepatitis B, inactivated
poliomyelitis, measles, mumps, meningococcal serogroup C, and
varicella.
 Currently, no data from clinical trials are available for co-
administration of PPSV23 with other childhood vaccines during the
same visit.

165.  Recommendations to separate Menactra brand MenACWY vaccine
(a meningococcal conjugate vaccine) and PCV13 only apply to
persons with functional or anatomic asplenia.
 If using Menactra brand MenACWY vaccine, you should give PCV13
first with a 4 week separation between the final dose of PCV13 and
Menactra.
 If using Menveo brand MenACWY give PCV13 at the same visit or
at any interval before or after each other.

166.  A CDC study has shown a small increased risk for febrile seizures
in some children during the 24 hours after a child receives the
inactivated influenza vaccine at the same time as the PCV13
vaccine or DTaP vaccine.
 However, the risk of febrile seizure with any combination of these
vaccines is small and ACIP recommends giving these vaccines at
the same visit if indicated.
 If PCV13 and influenza vaccine are both indicated and
recommended they should be administered at the same visit .

168. Where we ARE?? Where 2
go??

171. According to WHO, immunization averts
two to three million deaths annually;
however, an additional 1.5 million deaths
could be avoided if global vaccination
coverage improves.

175. Countries with current or planned use of pneumococcal conjugate vaccine
(PCV) in the national immunization program, as of September 2016
World Health Organization, Immunization Vaccines and Biologicals Database, September 2016

180. Pneumococcal conjugate vaccine introduction in EMR
Currently
offered to
65% of live
births
Palestine
Bahrain
Pneumococcal
vaccine introduction
Introduced (14)
Not introduced (8)
Palestine
Bahrain
Rotavirus
vaccine introduction
Introduced (11)
Not introduced (11)
Currently
offered to
30% of live
births
180
2015

184. Countries with current or planned use of pneumococcal conjugate vaccine
(PCV) in the national immunization program, as of September 2016
World Health Organization, Immunization Vaccines and Biologicals
Database, September 2016

185. Pneumococcal vaccine
had been introduced in
134 countries by the
end of 2016 & the global
coverage was estimated
at 42%.

186.  In May 2016, Only about half of the world’s countries have been
able to start using the PCV vaccine produced by Pfizer and
GlaxoSmithKline (GSK).
 One key barrier is the high price. This means that a growing
number of developing countries can't afford to buy the
pneumonia vaccine to protect their children.

192. “When meditating over a disease,
I never think of finding a remedy
for it, but, instead, a means of
prevention.”
Louis Pasteur
A Vision to future of humanity
192

193. “Immunizations are one of the world's biggest public health success stories.
But not all communities have the same access to vaccines .”
193

194. 194

195. 195

196. 196

197. 197

198. 198