Pneumococcal vaccination

What it is

There are two pneumococcal vaccines, and the exam point is always which patient gets which:

• 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13)
• 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23)

Some patients need both, and some need PPSV23 alone.

Causes and risk

Both PCV13 and PPSV23 are recommended for patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent persons younger than 65 are chronic lung disease, diabetes mellitus, chronic heart disease, smoking, and alcoholism. Other patients are vaccinated because of the disease they carry. In sickle cell disease the most common cause of sepsis is strep pneumo. In nephrotic syndrome, infection is the risk that pneumococcal vaccine answers. And in IBD it is the treatment that opens the door. In celiac disease the pneumococcal vaccine is offered as part of management, alongside the lifelong gluten free diet and measuring bone mineral density. Set out as a list, the pneumococcal polysaccharide vaccine is offered to all adults over the age of 65 years and to those with: asplenia or splenic dysfunction; chronic respiratory disease, that is COPD, bronchiectasis, cystic fibrosis and interstitial lung disease, with asthma included only if it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant; chronic heart disease, that is ischaemic heart disease if requiring medication or follow-up, heart failure and congenital heart disease, while controlled hypertension is not an indication for vaccination; chronic kidney disease at stages 4 and 5, nephrotic syndrome and kidney transplantation; chronic liver disease including cirrhosis and chronic hepatitis; diabetes mellitus if requiring medication; immunosuppression either due to disease or treatment, which includes any stage of HIV infection; cochlear implants; and cerebrospinal fluid leaks.