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FAQs by Doctors: Pneumococcal Vaccination

FAQs by Doctors: Pneumococcal Vaccination
2020-09-01
  1. Who should get pneumococcal vaccines?
  2. What is the difference between 23-valent pneumococcal polysaccharide vaccine (23vPPV) and 13-valent pneumococcal conjugate vaccines (PCV13)?
  3. Can Pneumococcal vaccines be given prior to / after certain medical procedures?
  4. What are the adverse events associated with 23-valent pneumococcal polysaccharide vaccine (23vPPV)?
  5. What are the adverse events associated with pneumococcal conjugate vaccines (PCV)?
  6. Who are not suitable to receive pneumococcal vaccines?
  7. What is the pneumococcal vaccine included in Vaccination Subsidy Scheme (VSS) 2020/21?
  8. Can pneumococcal vaccines be received together with seasonal influenza vaccine?

1. Who should get pneumococcal vaccines?

The Scientific Committee on Vaccine Preventable Diseases (SCVPD) recommends children under 2 years of age to receive pneumococcal conjugate vaccines (PCV) under the Hong Kong Childhood Immunisation Programme (HKCIP). The standard regimen includes a primary series of 2 doses at 2 and 4 months and a booster dose at 12 months.

SCVPD recommends high-risk individuals* aged 2 or above to receive a single dose of PCV13, followed by a single dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV) 1 year later. For those who have already received 23vPPV, a single dose of PCV13 should be administered 1 year after previous 23vPPV vaccination. For those who have already received PCV13, a single dose of 23vPPV should be administered 1 year after previous PCV13.

For elderly 65 years of age and older without high risk conditions*, SCVPD recommends either a single dose of PCV13 or a single dose of 23vPPV.

* High-risk conditions include:

(a) History of invasive pneumococcal disease

(b) Immunocompromised states:

  • Asplenia, HIV /AIDS, primary immunodeficiency
  • Immunodeficiencies related to malignancies and transplantation
  • Immunodeficiencies related to use of immunosuppressive drugs / systemic steroid

(c) Chronic disease

  • Chronic cardiac, pulmonary, liver or renal disease
  • Diabetes mellitus or CSF leakage

(d) With cochlear implants

(Essential hypertension per se is not considered as a high risk condition)

Different factors such as age and clinical condition may affect the risk of pneumococcal disease. Patients with high-risk conditions should discuss with their attending doctors on the most appropriate vaccination regimen.

Remarks: Under the Vaccination Subsidy Scheme, aside from the above list of high-risk conditions, elderly 65 years or above with chronic metabolic diseases, obesity (BMI 30 or above), chronic neurological conditions are eligible for subsidised PCV13.

2. What is the difference between 23-valent pneumococcal polysaccharide vaccine (23vPPV) and 13-valent pneumococcal conjugate vaccines (PCV13)?

PCV13 is effective against both invasive pneumococcal disease and non-invasive pneumococcal pneumonia. On the other hand, while clinical studies indicated that 23vPPV is generally effective in preventing IPD, its efficacy against non-invasive pneumococcal pneumonia is suboptimal. Nevertheless, it is worth noting that 23vPPV contains more serotypes and theoretically offers extra protection.

3. Can pneumococcal vaccines be given prior to / after certain medical procedures?

For individuals who will undergo elective splenectomy, pneumococcal vaccines should be given at least 2 weeks before the procedures if possible. Pneumococcal vaccines should ideally be given before or after completion of chemotherapy/radiotherapy but they may still be given as clinically indicated during long term use of chemotherapeutic agents.

4. What are the adverse events associated with 23-valent pneumococcal polysaccharide vaccine (23vPPV)?

23-valent pneumococcal polysaccharide vaccines (23vPPV) have been demonstrated to be safe. Common adverse reactions include slight swelling and tenderness at the injection site shortly following injection but most resolve within two days. Fever, muscle aches or more severe local reactions are uncommon.

5. What are the adverse events associated with 13-valent pneumococcal conjugate vaccines (PCV13)?

13-valent pneumococcal conjugate vaccines (PCV13) have been demonstrated to be safe. Common adverse reactions include slight swelling and tenderness at the injection site shortly following injection but most resolve within two days. Some may experience mild fever, fatigue, headache, chills, or muscle pain. Severe pain or difficulty in moving the arm where the shot was given was very rare.

6. Who are not suitable to receive pneumococcal vaccines?

Severe allergic reaction following a prior dose of pneumococcal vaccine or to the vaccine component or any diphtheria toxoid-containing vaccine is a contraindication to further doses of vaccine.

7. What is the pneumococcal vaccine included in Vaccination Subsidy Scheme (VSS) 2020/21?

23-valent pneumococcal polysaccharide vaccine and 13-valent pneumococcal conjugate vaccine are included in the scope of subsidised pneumococcal vaccination under VSS.

The subsidy of pneumococcal vaccinations for elderly aged 65 years or above (count by year of birth) is as follows:

  • Those without high-risk conditions* and have not received pneumococcal vaccination before, can receive subsidy for one dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV);
  • Those with high-risk conditions* and have not received pneumococcal vaccination before, can receive subsidy for one dose of 13-valent pneumococcal conjugate vaccine (PCV13) and subsidy for one dose of 23vPPV one year after;
  • Those with high-risk conditions* and have received 23vPPV before, can receive subsidy for one dose of PCV13 one year after the previous dose of 23vPPV;
  • Those with high-risk conditions* and have received PCV13 before, can receive subsidy for one dose of 23vPPV one year after the previous dose of PCV13.

* High-risk conditions include:

  • History of invasive pneumococcal disease, cerebrospinal fluid leakage or cochlear implant;
  • Chronic cardiovascular (except hypertension without complications), lung, liver or kidney diseases;
  • Metabolic diseases including diabetes mellitus or obesity (Body Mass Index 30 or above);
  • Immunocompromised states related to weakened immune system due to conditions such as asplenia, Human Immunodeficiency Virus Infection/Acquired Immune Deficiency Syndrome or cancer/steroid treatment; and
  • Chronic neurological conditions that can compromise respiratory functions or the handling of respiratory secretions, or increase the risk of aspiration, or those who lack the ability to take care of themselves.

8. Can pneumococcal vaccines be received together with seasonal influenza vaccine?

Yes. Both 23-valent pneumococcal polysaccharide vaccine (23vPPV) and pneumococcal conjugate vaccine (PCV) can be given together with other vaccines, including influenza vaccine, but they should be administered with a different syringe and at a different injection site.