Overview/Definition
Definition:
Pneumococcal vaccines protect against Streptococcus pneumoniae infections
PCV13 (13-valent pneumococcal conjugate vaccine) for infants and children, PPSV23 (23-valent polysaccharide vaccine) for high-risk children >2 years.
Epidemiology:
S
pneumoniae is leading cause of bacterial pneumonia, meningitis, and sepsis in Indian children
Case fatality rate 20-30% for invasive disease
Higher burden in children <2 years and immunocompromised individuals.
Age Distribution:
Highest incidence of invasive pneumococcal disease in infants <2 years
Secondary peak in adults >65 years
Conjugate vaccines most effective in youngest age groups due to immature immune systems.
Clinical Significance:
PCV13 introduction reduced invasive pneumococcal disease by 80% in vaccinated children
Herd immunity effects protect unvaccinated individuals
Critical component of routine childhood immunization programs.
Age-Specific Considerations
Newborn:
Maternal antibodies provide some protection for first 2-3 months
First PCV13 dose at 6 weeks (minimum 6 weeks of age)
No contraindication for preterm infants - use chronological age for scheduling.
Infant:
Primary series: 6, 10, 14 weeks with booster at 15-18 months per IAP recommendations
High-risk infants may need additional doses or PPSV23 after age 2 years
Monitor for fever and local reactions.
Child:
Catch-up vaccination for unvaccinated children 12-59 months
High-risk children >2 years need PPSV23 in addition to PCV13
Consider revaccination with PPSV23 every 5 years for highest risk groups.
Adolescent:
Generally not recommended unless high-risk conditions (immunodeficiency, chronic diseases)
PPSV23 indicated for asplenia, immunocompromise, chronic lung/heart disease
One-time revaccination may be needed.
Master Pneumococcal Vaccination with RxDx
Access 100+ pediatric videos and expert guidance with the RxDx app
Clinical Presentation
Symptoms:
Prevention-focused intervention
Pneumococcal disease symptoms include fever, chills, cough, chest pain, shortness of breath
Meningitis: headache, neck stiffness, photophobia
Sepsis: high fever, altered mental status.
Physical Signs:
Vaccine prevents disease
no specific signs from vaccination itself
Local reactions: Pain, redness, swelling at injection site
Systemic: Low-grade fever, irritability, decreased appetite, drowsiness.
Severity Assessment:
Mild local reactions: Pain, swelling <2 inches diameter
Moderate: Fever 38-39°C, moderate local swelling
Severe: High fever >39°C, extensive local swelling, systemic allergic reactions (rare).
Differential Diagnosis:
Post-vaccination reactions vs intercurrent illness, vaccine-associated fever vs bacterial/viral infections, local injection site reactions vs cellulitis, febrile seizures vs other causes of seizures.
Diagnostic Approach
History Taking:
Previous vaccination history, allergic reactions to vaccines or components, current illness status, immunodeficiency conditions, chronic diseases, medications affecting immune system, recent blood product administration.
Investigations:
No specific investigations needed for routine vaccination
Pre-vaccination assessment for contraindications
Post-vaccination monitoring for adverse events
Blood cultures if invasive pneumococcal disease suspected despite vaccination.
Normal Values:
Normal post-vaccination response: Local pain/swelling resolving in 1-2 days, low-grade fever <38.5°C lasting <24 hours
Antibody response measurable 2-4 weeks post-vaccination (research setting only).
Interpretation:
Successful immunization indicated by absence of vaccine-preventable pneumococcal disease
Breakthrough infections may occur with non-vaccine serotypes or vaccine failure
Herd immunity effects benefit entire community.
Management/Treatment
Acute Management:
Pre-vaccination screening for contraindications and precautions
Administer vaccine per recommended schedule
Post-vaccination monitoring for 15 minutes for immediate adverse reactions
Document vaccination in records.
Chronic Management:
Maintain updated vaccination records, schedule booster doses as recommended
Monitor for breakthrough infections
Educate about continued protection and herd immunity benefits
Address vaccine hesitancy concerns.
Lifestyle Modifications:
No specific lifestyle changes needed post-vaccination
Continue other preventive measures (hand hygiene, avoiding sick contacts)
Maintain routine pediatric care and growth monitoring
Normal activities can resume immediately.
Follow Up:
Next scheduled dose as per immunization schedule
Routine pediatric visits for growth and development monitoring
Contact healthcare provider for concerning post-vaccination symptoms lasting >2 days.
Age-Specific Dosing
Medications:
PCV13: 0.5 mL intramuscular injection
Standard schedule: 6, 10, 14 weeks + booster 15-18 months
PPSV23: 0.5 mL IM for high-risk children >2 years, given 8 weeks after last PCV13 dose.
Formulations:
PCV13 (Prevnar 13): Single-dose vial or pre-filled syringe containing 13 pneumococcal polysaccharides
PPSV23 (Pneumovax 23): Single-dose vial containing 23 pneumococcal polysaccharides
Both preservative-free.
Safety Considerations:
Contraindications: Severe allergic reaction to vaccine components or previous dose
Precautions: Moderate/severe acute illness, immunocompromised state (may have reduced response)
Can be given with other vaccines.
Monitoring:
Immediate: Monitor for anaphylaxis 15 minutes post-vaccination
Short-term: Fever, local reactions for 1-2 days
Long-term: Surveillance for vaccine-preventable diseases, breakthrough infections with non-vaccine serotypes.
Prevention & Follow-up
Prevention Strategies:
Complete primary series and boosters per schedule
High-risk children need additional protection with PPSV23
Maintain high population coverage for herd immunity
Continue other pneumonia prevention measures.
Vaccination Considerations:
Can be co-administered with routine vaccines at different injection sites
Space live vaccines 4 weeks apart if not given simultaneously
No interference with immune response to other vaccines.
Follow Up Schedule:
Per routine immunization schedule: 6, 10, 14 weeks, 15-18 months
High-risk children: PPSV23 at 2+ years, revaccination every 5 years for highest risk groups
Annual influenza vaccination recommended.
Monitoring Parameters:
Vaccination coverage rates, adverse events following immunization (AEFI), surveillance for invasive pneumococcal disease, serotype distribution changes, antibiotic resistance patterns.
Complications
Acute Complications:
Immediate: Anaphylaxis (rare, <1 per million doses), syncope
Early: Febrile seizures in susceptible children, severe local reactions
Most reactions mild and self-limiting.
Chronic Complications:
Vaccine failure (rare), breakthrough infections with non-vaccine serotypes, reduced herd immunity if coverage drops
Long-term local reactions extremely rare
No increased risk of autoimmune diseases.
Warning Signs:
Severe allergic reaction: Difficulty breathing, swelling of face/throat, hives, rapid pulse
High fever >40°C, extensive local swelling, persistent crying >3 hours, unusual sleepiness.
Emergency Referral:
Signs of anaphylaxis require immediate emergency treatment
Febrile seizures need urgent medical evaluation
Extensive local reactions or signs of secondary bacterial infection require medical assessment.
Parent Education Points
Counseling Points:
Pneumococcal vaccines are safe and highly effective in preventing serious infections
Minor side effects are common and expected
Benefits far outweigh risks
Vaccination protects child and community through herd immunity.
Home Care:
Monitor injection site for swelling, redness, tenderness (normal for 1-2 days)
Give acetaminophen/ibuprofen for fever or pain as directed
Apply cool compress to injection site
Maintain normal feeding and activities.
Medication Administration:
No specific medications needed unless fever/pain management required
Acetaminophen 10-15 mg/kg every 4-6 hours or ibuprofen 5-10 mg/kg every 6-8 hours for children >6 months
Avoid aspirin in children.
When To Seek Help:
Immediate medical attention for severe allergic reactions, difficulty breathing, extensive swelling
Contact healthcare provider for high fever >40°C lasting >24 hours, excessive crying, signs of infection at injection site.