What is the pneumococcal vaccine?
The pneumococcal vaccine protects one from invasive pneumococcal disease (IPD) caused by the bacteria Streptococcus pneumoniae (pneumococcus).
Pneumococcus can cause infections of the lungs (pneumonia), middle ear (otitis media), the tissue covering the brain and spinal cord (meningitis) and blood stream (bacteremia).
Pneumococcus is commonly found in the nose and throat of healthy people. It can spread via respiratory droplets from an infected person or during direct person to person contact. Not all who are exposed to the bacteria will develop an infection. Some become asymptomatic carriers while others get infected.
Adults aged 65 years and older, children aged 5 years or younger, and individuals with weakened immune systems or certain chronic medical conditions are at increased risk of IPD. Older adults at the greatest risk of serious illness and death.
What are the symptoms of pneumococcal disease?
Apart from fever, symptoms of pneumococcal disease depend on the organs affected.
Pneumonia – infection in the lungs may cause cough, chest pain or breathlessness
Otitis media – infection in the middle ear may cause ear pain
Meningitis – infection of the covering of the brain and spinal cord may cause headache, sensitivity to light, vomiting or neck stiffness
Bacteraemia – infection in the blood stream may cause lethargy or malaise
Sinusitis – infection in the sinuses may cause runny nose, blocked nose, or cough
Who should receive the pneumococcal vaccine?
All children aged 5 years or younger, especially infants
Adults aged 65 years and older
Those with weak immune systems or on medications that suppress the immune system
Chronic illnesses such as diabetes, heart, lung, kidney, or liver disease
Specific medical conditions such a person with cochlear implants or cerebrospinal fluid leaks, or absence of normal spleen function.
What are the different pneumococcal vaccines available in Singapore?
There are 2 categories of pneumococcal vaccines available to prevent IPD and pneumonia:
1. Pneumococcal Conjugate Vaccines (PCV 10, PCV 13 and PCV 20)
2. 23-valent Pneumococcal Polysaccharide Vaccine (PPSV 23)
Vaccine Types | 23-valent polysaccharide vaccine (PPSV 23)
| 10-valent conjugate vaccine (PCV 10) | 13-valent conjugate vaccine (PCV 13) | 20-valent conjugate vaccine (PCV 20) |
Description | Each dose contains pneumococcal polysaccharides from 23 serotypes | Each dose contains pneumococcal polysaccharides from 10 serotypes conjugated to carrier proteins
| Each dose contains pneumococcal polysaccharides from 13 serotypes conjugated to carrier proteins | Each dose contains pneumococcal polysaccharides from 20 serotypes conjugated to carrier proteins |
Approved age of use in Singapore
| 2 years and older | Below 5 years | 6 weeks and older | 19 years and older |
Government subsidy | Government subsidy for Singaporeans according to the National Immunisation Schedule.
| Government subsidy for Singaporeans according to the National Immunisation Schedule. | Government subsidy for Singaporeans according to the National Immunisation Schedule. | No government subsidy available. |
What are the recommendations for pneumococcal vaccination in children?
PCV is recommended for all children aged <5 years and persons aged 2-17 years who are at increased risk of developing IPD.
Babies require 3 doses of PCV given at 4, 6 and 12 months old. Children who did not receive PCV as per routine schedule are recommended to receive catch-up vaccination.
Children aged 2 years and above with specific medical conditions such as diabetes, heart, lungs, liver and kidney disease, cochlear implant, or cerebrospinal fluid leak, immunocompromised condition or absence of spleen function are recommended to get an additional dose of PPSV23.
What are the schedule options available for pneumococcal vaccine in adults?
Adults aged ≥ 65 years | 1. One dose of PCV 13 followed by one dose of either PPSV 23 or PCV 20 one year later. 2. One dose of PCV 20. There is no need for additional doses of pneumococcal vaccine thereafter. |
Adults aged ≥ 18 years with chronic diseases such as chronic lung disease, chronic heart disease, chronic liver disease and diabetes
| 1. One dose of PPSV 23. When patient turns 65, additional dose(s) of pneumococcal vaccine are needed (see adults aged ≥ 65 years) 2. One dose of PCV 20 (19 years and above). There is no need for additional doses of pneumococcal vaccine when patient turns 65.
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Adults aged ≥18 years with chronic kidney disease, cochlear implant, or cerebrospinal fluid leak
| 1. One dose of PCV 13 followed by one dose of either PPSV 23 or PCV 20. If PCV 20 is not administered, another dose of pneumococcal vaccine (either PPSV 23 or PCV 20) is needed when patient turns 65 years old. 2. One dose of PCV 20 (19 years and above). There is no need for additional doses of pneumococcal vaccine when patient turns 65.
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Adults aged ≥18 years with immunocompromising conditions or absence of normal spleen function
| 1. One dose PCV 13 followed by one dose of PCV 20 or two doses of PPSV 23. If PCV 20 was not administered, another dose of pneumococcal vaccine (either PPSV 23 or PCV 20) to be given when patient turns 65 years old. 2. One dose of PCV 20 (19 years old and above). There is no need for additional doses of pneumococcal vaccine when patient turns 65.
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N.B. The above schedule options table is a rough guide. Please talk to your healthcare provider for an individualized schedule.
PCV 20 offers a more convenient schedule as only one dose is required.
How can we help at Oaklife Family Clinic?
We carry PCV 13, PCV 20 and PPSV 23 vaccines.
Singaporean patients (children and adults) are also able to enjoy government subsidy for PCV 13 and PPSV 23 in our clinic according to the National Immunisation Schedule.
We can advise you and your family on the options of pneumococcal vaccine(s) tailored to your age, risk profile, vaccine schedule preference and government subsidy eligibility.
Written by Dr Jacquelyn Melody on 1 March 2024
References:
1. Handbook on adult vaccination in Singapore 2023 by Society of Infectious Disease (Singapore)
Disclaimer: this article is written for educational purposes and does not substitute for medical diagnosis and treatment.