Ideally this vaccine is indicated in all elderly over 65 yrs.
That said it is even more important in the following situations:
- Congestive cardiac failure
- COPD / ILD / bronchiectasis / asthma or any chronic lung disease
- Metastatic cancer / lymphoma / multiple myeloma
- Chronic alcoholism
- Chronic renal failure
- Nephrotic syndrome
- Immunosuppressed patients, e.g. those on steroids, chemotherapy, renal transplant candidates
- All diabetics
- All smokers
- All HIV infected persons
- Patients who have received cochlear implants
The vaccine is available as PPSV23 and PCV13.
PPSV23 refers to 23-valent pneumococcal polysaccharide vaccine which contains capsular polysaccharide antigens of 23 types of Streptococcus pneumoniae. It is the most commonly used vaccine. Some brands are Pneumo 23 (Sanofi) and Pneumovax (Merck).
PCV13 or Prevanar by Pfizer is the 13-valent pneumococcal vaccine which has been approved in children and now in adults over 50 years too. It has greater immunogenicity than PPSV23 and hence is better suited for immunocompromised patients.
Surprisingly and sadly, the pneumococcal vaccine DOES NOT EFFECTIVELY PREVENT pneumococcal pneumonia. It prevents invasive pneumococcal disease including pneumococcal septicemia and meningitis. These complications being commoner in the elderly, it is imperative to vaccinate all persons who are more than 65 years of age.
The side effects of this vaccine, which is to be injected in the deltoid area, are local redness, pain and induration.
Immunity develops after vaccination in 2 or 3 weeks.
In September 2014 the Advisory Committee on Immunization Practices (ACIP) recommended giving both vaccines in the elderly at a suitable time interval, for better protection, despite the costs incurred for the patient. (SEE CHART BELOW).