Pneumococcal Vaccine

Pathogenesis And Epidemiology

Infants and young children act as main reservoirs.
Nasopharyngeal carriage ranges from 27% to 85% globally.
Causes invasive pneumococcal disease including meningitis, bacteremia, and severe pneumonia.
Causes non-invasive disease including acute otitis media and sinusitis.
Highly prevalent serotypes in India include 1, 6B, 14, 19F, and 23F.

Macrolide resistance exceeds 70% in Asian isolates.
Penicillin and multidrug resistance frequently associated with serotypes 6B, 23F, 14, 9V, 18A, 18F, and 19A.

Unconjugated vaccine containing 25 µg capsular polysaccharide from 23 serotypes.
Elicits T-cell-independent B cell immune response.
Poorly immunogenic in children below 2 years of age.
Fails to induce immunologic memory.
Does not reduce nasopharyngeal carriage.
Cannot provide herd immunity.
Dosage: 0.5 mL, intramuscular or subcutaneous.
Administration site: Deltoid muscle.
Storage requirement: 2–8°C, do not freeze.

Organization	Primary Series	Booster Dose	Route & Site
Universal Immunization Programme (UIP)	Two doses at 6 and 14 weeks	Single booster at 9–12 months	0.5 mL Intramuscular, Anterolateral thigh
Indian Academy of Pediatrics (IAP)	Three doses at 6, 10, 14 weeks	Single booster at 15–18 months	0.5 mL Intramuscular, Anterolateral thigh

Age At First Dose	PCV-10/PCV-13 Primary Series	PCV-10/PCV-13 Booster Dose
7–11 months	Two doses 4 weeks apart	Single dose during 2nd year (minimum 8 weeks later)
12–23 months	Two doses 8 weeks apart	Not applicable
24–59 months	PCV-13: One dose. PCV-10: Two doses 8 weeks apart	Not applicable
≥60 months	Routine administration not recommended for healthy children	Not applicable

Chronic heart disease including cyanotic congenital heart disease and cardiac failure.
Chronic lung disease including asthma requiring prolonged high-dose oral corticosteroids.
Diabetes mellitus.
Cerebrospinal fluid leaks.
Cochlear implants.
Primary immunodeficiency, human immunodeficiency virus infection, immunosuppressive therapy.
Anatomic or functional asplenia, sickle cell disease.
Prematurity and very low birth weight.

Conjugate vaccines preferred over polysaccharide vaccines due to herd protection potential and superior immunogenicity.
PPSV23 strictly contraindicated below 2 years of age.

Age & Prior Vaccination	PCV-13 Recommendation	PPSV23 Recommendation
<23 months (Nil prior doses)	Age-appropriate routine recommendations	Not recommended
24–71 months (4 prior doses PCV-13)	None	Dose 1: 8 weeks after last PCV-13. Dose 2: 5 years after Dose 1
24–71 months (<3 prior doses PCV-13)	Two doses 8 weeks apart	Dose 1: 8 weeks after last PCV-13. Dose 2: 5 years after Dose 1
6–18 years (Nil prior doses)	One dose PCV-13	Dose 1: 8 weeks after PCV-13. Dose 2: 5 years after Dose 1

Maximum two doses of PPSV23 recommended per lifetime.
If cochlear implant placement planned, complete PCV-13 and PPSV23 vaccination 2 weeks prior to surgery.

Invasive pneumococcal disease: Pooled vaccine efficacy of 80% against vaccine-type disease.
Radiologically defined pneumonia: Pooled vaccine efficacy of 27%.
Acute otitis media: Relative risk reduction up to 53% for pneumococcal otitis media.
Effectiveness of one PCV-13 dose estimated at 48%, two doses at 87%, and three doses (2+1 schedule) at 100%.

Common events: Mild to moderate injection-site reactions (pain, redness, swelling), fever, irritability, decreased appetite, altered sleep patterns (10% of vaccinees).
Uncommon events: Fever >39°C (1% to 10%), vomiting, diarrhea (0.1% to 1%).
Rare events: Hypersensitivity reactions, convulsions, hypotonic-hyporesponsive episodes (<0.1%).