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Pneumococcal vaccination

Introduction

The pneumococcal vaccination (the pneumo jab) protects against pneumococcal infections.

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae, which is sometimes referred to as the pneumococcus bacterium. The bacterium can cause several conditions including:

  • pneumonia: inflammation (infection) of the lungs
  • septicaemia: a form of blood poisoning from an infection in the blood
  • meningitis: an infection of the membranes that surround the brain and spinal cord

Read more information about why pneumococcal vaccination is used.

At-risk groups

A pneumococcal infection can affect anyone. However, some groups of people need the vaccination because they have a higher risk of an infection developing into a serious health condition. These include:

  • children under the age of two (as part of the childhood vaccination programme)
  • adults aged 65 or over
  • children and adults with certain chronic (long-term) health conditions, such as a serious heart or kidney condition

Read more information about when the pneumococcal vaccine is used.

Types of pneumococcal vaccine

There are two different types of pneumococcal vaccine:

  • Pneumococcal conjugate vaccine (PCV): this is given to all children under two years old as part of the childhood vaccination programme.
  • Pneumococcal polysaccharide vaccine (PPV): this is given to people aged 65 or over, and to people at high risk due to chronic health conditions.

More than 90 different strains of the pneumococcal bacterium have been identified, with the most serious infections caused by 8-10 strains.

The PCV protects against 13 strains of the pneumococcal bacterium, and the PPV protects against 23 strains.

PPV is thought to be around 50%-70% effective at preventing more serious types of pneumococcal disease.

Read about how the pneumococcal vaccine works for more information about the two types of vaccine.

Things to consider before vaccination

In rare cases the vaccination may need to be delayed, or may not be safe to have. The reasons are listed below.

  • Allergic reactions. Tell your GP if you've had a bad reaction to any vaccination in the past. If you have had a confirmed anaphylactic reaction (a severe allergic reaction) to the vaccine, or any ingredient in the vaccine, you should not have it. However, if it was only a mild reaction, such as a rash, it is probably safe for you to have the vaccine.
  • Being unwell. If you're mildly unwell at the time of the vaccination, it is still safe to have the vaccine. However, if you are "actively unwell", for example, if you have a high temperature (fever), it is likely that the vaccination will be delayed. This is because it will be difficult to tell the difference between the symptoms of your condition and a bad reaction to the vaccine.
  • Pregnancy and breastfeeding. The pneumococcal vaccine is thought to be safe to receive during pregnancy and breastfeeding. As a precaution, if you are pregnant, you may be advised to wait until you have had your baby (unless the benefits of having the vaccine outweigh the risks to your child).
  • Suppressed immune system. If you have a suppressed immune system, for example, because you have HIV or AIDS, you may need to have extra doses of the pneumococcal vaccination. This is because you may not produce enough antibodies (proteins that destroy disease-carrying organisms) to provide immunity after the standard dose of the vaccine. Ask your GP for more information.

Side effects

Although the pneumococcal vaccinations are considered safe and rarely cause problems, both the PCV and PPV vaccines can cause mild side effects including:

  • a slightly raised temperature (mild fever)
  • redness at the site of the injection
  • hardness or swelling at the site of the injection

In rare cases, some people react badly to the vaccine and develop serious side effects. If you develop any unusual symptoms after having the vaccination, call your GP or NHS Direct Wales on 0845 46 47.

Read more information about the side effects of the pneumococcal vaccination.

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Why it is used.

The pneumococcal vaccination (pneumo jab) prevents pneumococcal infections that can otherwise lead to fatal health conditions.

How infections spread

Pneumococcal infections are easily spread by close or prolonged contact with someone who has the infection.

The pneumococcal bacteria are present in tiny droplets that are expelled when an infected person breathes, coughs or sneezes. If you inhale these droplets, you may also be infected.

You can also become infected by touching any droplets that might have landed on a surface, such as a table, and then transferring them to your face.

Once the bacteria have entered your body, usually through your nose or throat, they can either lie dormant (which means they do not cause you any harm, but they could still be passed onto someone else), or they can multiply and cause health problems such as pneumonia (inflammation of the lungs).

For pneumococcal infections, the incubation period (the time between catching an infection and showing symptoms) is thought to be around one-to-three days.

Types of infections

Pneumococcal infections are usually one of the following types:

  • Non-invasive pneumococcal infections: these occur outside the major organs and tend to be less serious, for example, otitis media (a middle ear infection).
  • Invasive pneumococcal infections: these occur inside a major organ or in the blood and tend to be more serious, for example, meningitis (an infection of the brain).

Every year in England and Wales, 5,000 to 6,000 cases of invasive pneumococcal infections are reported to the Health Protection Agency (HPA).

At-risk groups

Pneumococcal infections are more serious in children, older people and people with certain chronic (long-term) health conditions. This is why these groups are offered a pneumococcal vaccination on the NHS.

Read more about when the pneumococcal vaccine is used.

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How does it work?

There are two different vaccines that protect you against pneumococcal infections:

  • pneumococcal conjugate vaccine (PCV), used to vaccinate children under the age of two years old
  • pneumococcal polysaccharide vaccine (PPV), used to vaccinate adults who are 65 or over, and people at high risk due to chronic health conditions

Both vaccines are given by injection, usually into your upper arm, and contain several different strains of pneumococcal bacteria. For infants under the age of one, the injection may be given into the upper leg (thigh).

The pneumococcal vaccine encourages your body to produce antibodies against pneumococcal bacteria. Antibodies are proteins produced by the body to neutralise or destroy disease-carrying organisms and toxins. They protect you from becoming ill if you are infected with the bacteria.

The aim of the vaccine is to protect against most pneumococcal bacteria, although there is no guarantee that you will be immune to all types of the bacteria.

Pneumococcal conjugate vaccine

The pneumococcal conjugate vaccine (PCV) is recommended for children under two years old and is offered as part of the childhood vaccination programme.

A newer version of the PCV, approved in 2010, protects against 13 strains of pneumococcal bacteria.

Pneumococcal polysaccharide vaccine

The pneumococcal polysaccharide vaccine (PPV) is recommended for adults over 65 years old and for children and adults aged from two to 64 years old who are considered to be at higher risk because of a chronic (long-term) health condition.

The PPV protects against 23 types of pneumococcal bacteria. According to the Health Protection Agency (HPA), this covers 96% of the types of pneumococcal bacteria that can cause serious diseases in the UK.

Children at risk are given the PPV at two years old because it does not protect those who are younger.

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When it is used

There are three groups of people who need to be vaccinated against pneumococcal infections.

Children under two years of age

Children are vaccinated with the pneumococcal conjugate vaccine (PCV) as part of their childhood vaccination programme. The programme consists of three injections usually given at:

  • two months old
  • four months old
  • 13 months old

If a child under five years old who is at high risk (see high-risk groups below) does not complete the course of childhood vaccinations, it may be recommended that they have either a single or double dose of the PCV. 

Adults aged 65 or over

If you are 65 or over you will need to have the pneumococcal polysaccharide vaccine (PPV). This one-off vaccination will protect you against serious forms of pneumococcal infection.

High-risk groups

It is recommended that children and adults aged from two to 64 years old should have the PPV if they are at a higher risk of developing a pneumococcal infection than the general population. Children up to five years old who are at high risk may also need the PCV.

You may be at a higher risk if you have:

  • had your spleen (an organ that helps filter your blood) removed, or your spleen does not work properly
  • chronic (long-term) respiratory disease, for example, chronic obstructive pulmonary disease (the name for a collection of lung diseases that make it difficult to breathe)
  • chronic heart disease, for example, congenital heart disease (a birth defect that affects the heart)
  • chronic kidney disease, for example, nephrotic syndrome (when protein leaks from the blood into your urine)
  • chronic liver disease, for example, liver cirrhosis (when healthy tissue in the liver is destroyed and replaced by scar tissue)
  • diabetes (a long-term condition caused by too much glucose in the blood) that requires insulin or other medications to lower blood sugar levels
  • a suppressed immune system (the body’s defence system) caused by a health condition, such as HIV
  • a suppressed immune system caused by medication such as chemotherapy (a cancer treatment) or steroids (medication that contains powerful chemicals called hormones)
  • a cochlear implant (a small hearing device that can be fitted inside your ear if you have a hearing impairment) 
  • had cerebrospinal fluid (CSF: the clear fluid that surrounds the brain and spine) leaking from its usual position, for example, as the result of an accident or surgery

Booster doses

If you are at increased risk of a pneumococcal infection you will be given the PPV vaccination just once. For most adults, this will protect you for life.

However, if your spleen does not work properly, or if you have a chronic kidney condition, you may need booster doses of PPV every five years. This is because your levels of antibodies (proteins that destroy disease-carrying organisms) against the infection will decrease over time.

Missed doses

If you or your child has missed a dose of either of the pneumococcal vaccines, it will be assumed the vaccination is incomplete. Speak to your GP about when you can complete the vaccination programme.

If your child is under the age of one and has missed a dose of the PCV vaccine, they should receive the remaining doses they need with two months between each dose.

If your child is over one but under two years old and has missed a dose of the PCV vaccine, they should be given a single dose of the PCV vaccine.

If your child is over two but under five years old and has missed a dose of the PCV vaccine, they may need a single dose of the PCV vaccine. However, this may only be recommended if your child is at high risk (see high-risk groups, above). Speak to your GP for further advice.

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Side effects

Pneumococcal vaccinations are considered safe and rarely cause problems. For example, you can't catch a pneumococcal infection from the injection because the vaccine doesn't contain any live bacteria.

Pneumococcal conjugate vaccine (PCV)

Possible side effects of the pneumococcal conjugate vaccine (PCV) include:

  • decreased appetite
  • a slightly raised temperature (mild fever)
  • irritability
  • redness at the site of the injection
  • hardness or swelling at the site of the injection
  • feeling sleepy
  • not sleeping well

Pneumococcal polysaccharide vaccine (PPV)

Possible side effects of the pneumococcal polysaccharide vaccine (PPV) include:

  • mild soreness or hardness at the site of the injection lasting one-to-three days
  • a slightly raised temperature (mild fever)

Serious side effects

In rare cases some people react badly and develop serious side effects. If you notice any unusual symptoms after being vaccinated, call your GP or NHS Direct Wales on 0845 46 47.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine that you are taking. It is run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA). See the Yellow Card Scheme website for more information.

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Cautions

Allergic reactions

Before having a pneumococcal vaccination, tell your GP if you've had a bad reaction to any vaccination in the past.

If you have had a confirmed anaphylactic reaction (a severe allergic reaction) to the vaccine, or any ingredient in the vaccine, you shouldn't have it. However, if it was only a mild reaction, such as a rash, it's probably safe for you to have the vaccine.

Being unwell

If you are mildly unwell at the time of the vaccination, it's still safe to have the vaccine. However, if you are "actively unwell", for example, if you have a high temperature (fever), it is likely that the vaccination will need to be delayed. This is because it would be difficult to tell the difference between the symptoms of your condition and a bad reaction to the vaccine.

Pregnancy and breastfeeding

The pneumococcal vaccine is thought to be safe to have during pregnancy and breastfeeding. As a precaution, if you are pregnant, you may be advised to wait until you have had your baby (unless the benefits of having the vaccine outweigh the risks to your baby).

Suppressed immune system

If you have a suppressed immune system, for example, because you have HIV or AIDS, you may need extra doses of the pneumococcal vaccination. This is because you may not produce enough antibodies (proteins that destroy disease-carrying organisms) to provide immunity after the standard dose of the vaccine. Ask your GP for more information.

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