Pneumonia jab

hi I discussed having the pneumonia jab and said I couldn't have the live vaccine ,they checked up and said the only time you don't have the live vaccine is if your spleen has ben removed or damaged , mine is enlarged they gave me the live vaccine my arm feels like some one has used it as a punch bag under my arm were lymph nodes are enlarged is aching I feel cold and shivering with the central heating on is it the vaccine julie

9 Replies

  • You should be calling and seeing your doctor, today... or head to emergency care

    The pneumonia injection vaccines are not live vaccines, the nasal spray used on children is live.


  • so it shouldn't be the pneumonia injection then thanks julie

  • You can still have a reaction to a non live vaccine, but I'm not a doctor...

  • No I have also had the Pneumonia injection as advised by my Haemotologist. I was fine with it, it isn't a live vaccine.

  • I agree see your doctor just in case!

    I am also under the impression that the pneumonia jab is not live so you have been given duff info in my opinion.


  • Doubly duff in my non-medically trained opinion. I agree with Chris that you will have been given a non-live injection and they have got it kind of wrong about the spleen. Live vaccinations should not be given to immune compromised patients, irrespective of whether they have a spleen. If they'd had a splenectomy, then an even more stringent prophylactic protocol kicks in but I don't know the details and it isn't relevant to you in any case.


  • feel a bit better today maybe just a bug and it co in sided with having the injection

  • The vaccine question comes up regularly so I saved lots of the previous comments and pasted the long version here:

    Whenever Pneumonia vaccines and Flu vaccines get discussed then Shingles vaccines and Hepatitis vaccines invariably come up also.

    So first, the ones we should NEVER take are live vaccines like Shingles this is reinforced by this 2010 comment from Terry Hamblin:

    "CLL is different from other leukemias. A complete remission does not restore immune competence. Patients with CLL are immunocompromised from diagnosis until death." Terry Hamblin MD FMedSci

    The CDC comprehensive position paper is found here:

    Page 19 starts the discussion for immunocompromised patients

    Page 21 has this statement:

    Vaccination with Live, Attenuated Viral and Bacterial Vaccines

    Severe complications have followed vaccination with live, attenuated viral and live, attenuated bacterial vaccines among persons with altered immunocompetence (137–145). Persons with most forms of altered immunocompetence should not receive live vaccines (MMR, varicella, MMRV, LAIV, zoster, yellow fever, Ty21a oral typhoid, BCG, and rotavirus).

    However one of the most common killers of CLL patients is Pneumonia so for the official CDC -- ACIP version see:

    The short version is: ACIP Recommendations for PCV13 and PPSV23 Use

    Adults with specified immunocompromising conditions who are eligible for pneumococcal vaccine should be vaccinated with PCV13 during their next pneumococcal vaccination opportunity.

    Pneumococcal vaccine-naïve persons. ACIP recommends that adults aged ≥19 years with immunocompromising conditions, .... who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later (Table). Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk. Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19–64 years ..... for persons with immunocompromising conditions. Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years, or later if at least 5 years have elapsed since their previous PPSV23 dose.

    Previous vaccination with PPSV23. Adults aged ≥19 years with immunocompromising conditions,..., who previously have received ≥1 doses of PPSV23 should be given a PCV13 dose ≥1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.

    IMO- the recommendations for Flu & Hepatitis are less clear so:

    This is what LLS says on their website: • In general, patients undergoing cancer treatment are advised to receive a flu shot rather than the nasal mist form of the flu vaccine. Shots are safe for people with compromised immune systems because they are made from inactivated virus; the flu mist is made from a live virus.

    Thanks to Chris Dwyer for posting this at Health Unlocked

    That is a more specific comment on Hepatitis vaccines clarifying that they are NOT live vaccines but Subunit and Conjugate Vaccines

    Both subunit and conjugate vaccines contain only pieces of the pathogens they protect against.

    Subunit vaccines use only part of a target pathogen to provoke a response from the immune system. This may be done by isolating a specific protein from a pathogen and presenting it as an antigen on its own. The acellular pertussis vaccine and influenza vaccine (in shot form) are examples of subunit vaccines.

    Another type of subunit vaccine can be created via genetic engineering. A gene coding for a vaccine protein is inserted into another virus, or into producer cells in culture. When the carrier virus reproduces, or when the producer cell metabolizes, the vaccine protein is also created. The end result of this approach is a recombinant vaccine: the immune system will recognize the expressed protein and provide future protection against the target virus. The Hepatitis B vaccine currently used in the United States is a recombinant vaccine.

    Another vaccine made using genetic engineering is the human papillomavirus (HPV) vaccine. Two types of HPV vaccine are available—one provides protection against two strains of HPV, the other four—but both are made in the same way: for each strain, a single viral protein is isolated. When these proteins are expressed, virus-like particles (VLPs) are created. These VLPs contain no genetic material from the viruses and can’t cause illness, but prompt an immune response that provides future protection against HPV.

    Conjugate vaccines are somewhat similar to recombinant vaccines: they’re made using a combination of two different components. Conjugate vaccines, however, are made using pieces from the coats of bacteria. These coats are chemically linked to a carrier protein, and the combination is used as a vaccine. Conjugate vaccines are used to create a more powerful, combined immune response: typically the “piece” of bacteria being presented would not generate a strong immune response on its own, while the carrier protein would. The piece of bacteria can’t cause illness, but combined with a carrier protein, it can generate immunity against future infection. The vaccines currently in use for children against pneumococcal bacterial infections are made using this technique.

    A position paper specific to Hepatitis is here:

    Can Hepatitis B vaccine be given to immunocompromised persons, such as persons on hemodialysis or persons with HIV infection?

    Yes, although a larger vaccine dose is required to induce protective antibody in hemodialysis patients. Larger doses or additional doses might also be necessary for other immunocompromised persons. Serologic testing of hemodialysis patients and other immunocompromised persons is recommended 1–2 months after administration of the final dose of the primary vaccine series to determine the need for revaccination. Detailed guidance on vaccination of hemodialysis patients and other immunocompromised persons is available from the Advisory Committee on Immunization Practices recommendations on adult Hepatitis B vaccination

    (available at Adobe PDF file [PDF - 40 pages]).

    CLL. Antibody responses, pneumonia vaccines etc. British Journal of Haematology 28 APR 2015

    Poor functional antibody responses are present in nearly all patients with chronic lymphocytic leukaemia, irrespective of total IgG concentration, and are associated with increased risk of infection

    Snip…..’Chronic lymphocytic leukaemia (CLL) patients suffer considerable morbidity and mortality from infectious disease. This risk has been attributed to the development of a secondary immunodeficiency with a multi-factorial aetiology, including the effects of the underlying disease’.

    ‘ Total immunoglobulin G (IgG) concentration is the most commonly used indicator of antibody deficiency but the magnitude of the humoral response against specific pathogens is also of considerable importance’

    ‘We undertook a cross-sectional study to examine the incidence of specific antibody deficiency in 56 CLL patients over 3 weeks at Queen Elizabeth Hospital Birmingham and Birmingham Heartlands Hospital Haematology clinics in June 2013.’

    ‘As previously reported (Hamblin & Hamblin, 2008), a high incidence of infection was observed even in patients with early stage disease.’

    ‘Three patients received Prevenar13 and the remainder had been given Pneumovax23. This suggests that a more robust system of vaccination is required with clear guidelines on whether this should occur in primary or secondary care. At the time of study the Joint Committee on Vaccination and Immunization (JCVI) had recently changed their guidance for haematological malignancy and now recommend that patients should be immunized with the conjugated vaccine Prevenar13 followed, at least 6 months later, by the previously recommended vaccine, Pneumovax23 ( last accessed 30 March 2015).

    This study supports this decision in that we found patients who had received Pneumovax23 polysaccharide vaccine (n = 37) had protective levels against only 2 of 12 compared with 4 of 12 pneumococcal serotypes for unvaccinated patients.’

    ‘This cross-sectional study highlights the importance of investigating for antibody deficiency even in the early stages of CLL and supports a strategy of examining both whole and specific antibodies. Vaccination status should be checked on an annual basis. Enhanced vaccine regimens and additional strategies, such as prophylactic antibiotics or immunoglobulin replacement therapy, are required to reduce the high morbidity and mortality of infection in CLL.’

    Followed by a useful long list of reference publications

    Also a full PDF is at :-


    Appendix: Pneumococcal Vaccines (PCV13 and PPSV23)

    Disease Issues Boosters and Revaccination (PPSV23)

    Vaccine Recommendations (PCV13)Miscellaneous PPSV23 Issues

    PCV13 for Adults with Medical ConditionsScheduling and Documenting Vaccines

    Miscellaneous PCV13 IssuesAdministering Vaccines

    Vaccine Recommendations (PPSV23)Vaccination Strategies

    Disease Issues What causes pneumococcal disease?

    Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium that has more than 90 serotypes. Most serotypes cause disease, but only a few produce the majority of invasive pneumococcal disease. The 10 most common types cause 62% of invasive disease worldwide.

    How does pneumococcal disease spread?

    The disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%-70% of normal, healthy adults.

    How long does it take to show signs of pneumococcal disease after being exposed?

    As noted above, many people carry the bacteria in their nose and throat without ever developing invasive disease. The incubation period for specific diseases caused by an invasive pneumococcal infection is noted below.

    What are the types of invasive pneumococcal disease?

    There are two major clinical syndromes of invasive pneumococcal disease: bacteremia, and meningitis. They are both caused by infection with the same bacteria, but have different manifestations.

    Pneumococcal pneumonia is the most common disease caused by pneumococcal infection. Pneumococcal pneumonia can occur in combination with bacteremia and/or meningitis, or it can occur alone. Isolated pneumococcal pneumonia is not considered invasive disease but it can be severe. It is estimated that 175,000 cases occur each year in the United States. The incubation period is short (1-3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.

    Pneumococcal bacteremia occurs in about 25%-30% of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococcal bacteremia occur each year in the United States. Bacteremia is the most common clinical presentation among children less than two years, accounting for 70% of invasive disease in this group.

    Pneumococci cause 13%-19% of all cases of bacterial meningitis in the United States. There are 3,000-6,000 cases of pneumococcal meningitis each year. Symptoms and signs may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children less than one year have the highest rate of pneumococcal meningitis, approximately 10 cases per 100,000 population. The mortality rate is high (30% overall, up to 80% in the elderly).

    How serious is pneumococcal disease in the U.S?

    Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined.

    An estimated 36,850 cases and 4,250 deaths from invasive pneumococcal diseases (bacteremia and meningitis) occurred in the United States in 2011. More than half of these cases occurred in adults who had an indication for pneumococcal polysaccharide vaccine. Young children and the elderly (younger than age five years and older than 65) have the highest incidence of serious disease.

    Case-fatality rates are highest for pneumococcal meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20% among adults. Among elderly patients, this rate may be as high as 60%.

    Vaccine Recommendations (PCV13)

    When were the first conjugate vaccines licensed?

    In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of Streptococcus pneumoniae and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten years later in February 2010, a new 13-valent product was licensed — PCV13 (Prevnar 13, Pfizer) — which added 6 new serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes account for the majority of invasive pneumococcal disease (IPD) in the U.S., including serotype 19A, which is the most common IPD-causing serotype in young children. In February 2010 ACIP recommended that healthcare providers transition from use of PCV7 to use of PCV13 for routine vaccination of children.

    PCV7 was initially recommended for routine use in infants and children ages 2 through 59 months. The recommendations were expanded with the licensure of PCV13 to include vaccination of children age 60 through 71 months with underlying medical conditions, and also permissive recommendations to consider vaccination of older children, ages 6 through 18 years, with medical conditions placing them at increased risk of invasive pneumococcal disease. In late 2011, a supplement was issued to the FDA license for expanded use of PCV13 in adults.

    What are the recommendations for routine vaccination of children with PCV13?

    All infants should be given a primary series of PCV13, at ages 2, 4, and 6 months with a booster at age 12 to 15 months. Children who fall behind should be given catch-up vaccination through age 59 months, if otherwise healthy or, through age 71 months if they have certain underlying medical conditions.

    What are the recommendations for vaccinating children who previously received PCV7?

    The table below can help guide the vaccination of infants and children who are in various stages of PCV vaccination (i.e., unvaccinated, begun a series of PCV7 or PCV13 but not yet completed, or have completed a series of PCV7).

    Recommended Schedules for Administering Pneumococcal Conjugate Vaccine (PCV) to Children

    By PCV Vaccination History and Age

    Child's age nowVaccination History of PCV7 and/or PCV13Recommended PCV13 Schedule

    (see footnote* below for minimum intervals between doses)

    2 through 6 months0 dose3 doses, 8 weeks apart; 4th dose at age 12-15 months

    1 dose2 doses, 8 wks apart; 4th dose at age 12-15 months

    2 doses1 dose, at least 8 weeks after the most recent dose; dose #4 at age 12-15 months

    7 through 11 months0 doses2 doses. 8 wks apart; dose #3 at age 12-15 months

    1 or 2 doses before age 7 months1 dose at age 7-11 months, with a second dose at age 12-15 months (8 wks later)

    12 through 23 months0 doses2 doses, at least 8 weeks apart

    1 dose before age 12 months2 doses, at least 8 weeks apart

    1 dose at or after age 12 months1 dose, at least 8 weeks after the most recent dose

    2 or 3 doses before age 12 months1 dose, at least 8 weeks after the most recent dose

    4 doses of PCV7 or other age-appropriate, complete PCV7 schedule1 supplemental dose, at least 8 weeks after the most recent dose

    24 through 59 months

    (healthy)Unvaccinated or any incomplete schedule1 dose, at least 8 weeks after the most recent dose

    4 doses of PCV7 or other age-appropriate, complete PCV7 schedule1 dose, at least 8 weeks after the most recent dose

    24 through 71 months

    (with risk factor)Unvaccinated or any incomplete schedule2 doses, one at least 8 weeks after the most recent dose and another dose at least 8 weeks later

    Any incomplete schedule of 3 doses1 supplemental dose, at least 8 weeks after the most recent dose

    4 doses of PCV7 or other age-appropriate complete PCV7 schedule1 supplemental dose, at least 8 weeks after the most recent dose

    *The minimum interval between doses of PCV7 or PCV13 administered at younger than 12 months of age is 4 weeks. The minimum interval for the next-to-last to last dose is 8 weeks.

    Many children in my practice have received their complete series of 7-valent pneumococcal conjugate vaccine (PCV7). Would you please review the recommendations for which of them now need a supplemental dose of 13-valent pneumococcal conjugate vaccine (PCV13)?

    A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months who have received the complete 4-dose series of PCV7 or another age-appropriate, complete PCV7 schedule. For children who have underlying medical conditions, a single supplemental PCV13 dose is recommended through age 71 months. This also includes children who have previously received pneumococcal polysaccharide vaccine (PPSV23). Give the single supplemental dose of PCV13 no sooner than 8 weeks after the last dose of PCV7 or PPSV23 was given.

    IAC has created a table that explains how to use PCV13 to catch up children who have fallen behind on their PCV7 doses. It is available at

    PCV13 for Adults with Medical Conditions

    Which adults are now recommended to receive a dose of PCV13?

    Adults age 19 years and older who have the conditions specified below and who have not previously received PCV13 should receive a PCV13 dose during their next vaccination opportunity.

    •Immunocompromising conditions (e.g., congenital or acquired immunodeficiency, HIV, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, and multiple myeloma)

    •Functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies and congenital and acquired asplenia)

    •Cerebrospinal fluid (CSF) leak

    •Cochlear implants

    Can we administer either the pneumococcal polysaccharide or the pneumococcal conjugate vaccine to patients with multiple sclerosis?

    Multiple sclerosis is not a contraindication to any vaccine, including either of the pneumococcal vaccines.

    Miscellaneous PCV13 Issues

    A 2-month-old was mistakenly given PPSV23 instead of PCV13. What should be done?

    PPSV23 is not effective in children less than 24 months of age. PPSV23 given at this age should not be considered to be part of the pneumococcal vaccination series. PCV13 should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified.

    Do children who are diagnosed with pneumococcal disease still need to receive pneumococcal conjugate vaccine?

    Yes. There are several different serotypes of Streptococcus pneumoniae that cause disease in children. A child who has had pneumococcal disease has only developed antibody against one serotype.

    Vaccine Recommendations (PPSV23)

    When were the first vaccines licensed for vaccination against pneumococcal disease?

    The first pneumococcal vaccine, licensed in 1977, was a polysaccharide vaccine. It contained purified capsular polysaccharide antigen from 14 different types of pneumococcal bacteria. In 1983, a 23-valent polysaccharide was licensed (PPSV23). It replaced the 14-valent vaccine.

    For whom is the 23-valent pneumococcal polysaccharide vaccine (PPSV23) recommended?

    PPSV23 vaccine is recommended for all people who meet any of the criteria below:

    1. All adults age 65 yrs and older

    2. Age 2 through 64 yrs with any of the following conditions:

    a.cigarette smokers age 19 yrs and older

    b.chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies; excluding hypertension)

    c.chronic pulmonary disease (including COPD and emphysema, and for adults ages 19 years and older, asthma)

    d.diabetes mellitus


    f.chronic liver disease, cirrhosis

    g.candidate for or recipient of cochlear implant

    h.cerebrospinal fluid (CSF) leak

    i.functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)

    j.immunocompromising conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy

    k.solid organ transplantation; for bone marrow transplantation,

    l.chronic renal failure or nephrotic syndrome

    Public health authorities may also consider recommending PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.

    Which children should receive PPSV23 vaccine (in addition to PCV13)? At what age should they receive it?

    PPSV23 is recommended for children with an immunocompromising condition, or functional or anatomic asplenia, and also for immunocompetent children with chronic heart disease, chronic lung disease, diabetes mellitus, cerebrospinal fluid leak, or cochlear implant. Administer 1 dose of PPSV23 to children age 2 years and older at least 8 weeks after the child has received the final dose of PCV13. Children with an immunocompromising condition, or functional or anatomic asplenia should receive a second dose of PPSV23 5 years after the first PPSV23.

    Is pneumococcal polysaccharide vaccine (PPSV23) contraindicated in pregnancy? Our patient has asthma and is pregnant.

    No. According to the 2014 adult immunization schedule, PPSV23 is recommended in pregnancy if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications). See footnote 9 of the 2014 adult immunization schedule

    Can you please explain when and why the recommendations for vaccination were changed for people with asthma and for cigarette smokers?

    The 1997 CDC recommendations for the use of PPSV exclude asthma in the chronic pulmonary disease category because no data on increased risk of pneumococcal disease among people with asthma were available when the recommendation was issued. In 2008, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. ACIP also reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP recommends to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV23.

    Since PPSV23 is recommended for all adults who smoke, should adults who use smokeless tobacco products (e.g., chewing tobacco) be vaccinated too?

    No. ACIP does not identify people who use smokeless tobacco products as being at increased risk for pneumococcal disease or as being in a risk group for vaccination.

    Currently, ACIP recommends pneumococcal polysaccharide (PPSV23) for smokers age 19–64 years. Should we also vaccinate 16-year-olds who smoke?

    No. Currently no data exist to indicate that people younger than 19 and smoke are at increased risk of pneumococcal disease.

    Is pneumococcal polysaccharide vaccine (PPSV23, Pneumovax, Merck) indicated for former smokers?

    PPSV23 is currently recommended for people age 19 through 64 years who actively smoke cigarettes (see However, chronic lung disease is an indication for PPSV23, which could be applicable for former smokers.

    In its September 2010 publication of updated recommendations for prevention of invasive pneumococcal disease among adults, ACIP recommends vaccinating adult asthmatics with PPSV23. Should I give PPSV23 to people with mild, intermittent asthma or exercise-induced asthma? Why isn't PPSV23 recommended for asthmatic children?

    PPSV23 is recommended for adults 19 years and older with all types of asthma. Available data do not indicate that asthma alone increases the risk of invasive pneumococcal disease among people younger than 19 years, so PPSV23 is not currently recommended for people younger than 19 years with asthma. For more information, go to

    Should people who are HIV positive receive pneumococcal vaccines?

    Yes. People with HIV infection should receive both PCV13 and PPSV23 vaccines as soon as possible after diagnosis. They should first be given PCV13, followed by PPSV23 8 weeks later. If they are younger than age 65 years, they will need a second dose of PPSV23 at least 5 years after their initial dose and a third dose once they become age 65 years. If they are age 65 years or older when first diagnosed, they will need only one dose. The risk of pneumococcal infection is up to 100 times greater in HIV-infected people than in other adults of similar age. Although severely immunocompromised people may not respond well to the vaccine, and there is a chance that the vaccine may not produce an antibody response, the risk of disease is great enough to warrant vaccination.

    How often should diabetic patients receive pneumococcal polysaccharide vaccine?

    People with diabetes who are ages 2 through 64 years who have not already received a dose of PPSV23 should receive their first dose now. At age 65 years they should receive a one-time revaccination if 5 years have elapsed since the previous dose.

    Pneumococcal polysaccharide vaccine (PPSV, Pneumovax, Merck) is recommended for people with diabetes. Does this include gestational diabetes?


    How often should adult dialysis patients receive pneumococcal polysaccharide vaccine?

    Adult dialysis patients younger than age 65 years need a dose of PPSV23 followed by a second dose 5 years later; once they become 65, they will need another dose. If they were age 65 years or older when first vaccinated, only one dose of PPSV23 is recommended.

    Is there any reason to withhold pneumococcal vaccine from a healthy non-smoking 45-year old who requests it to decrease his/her risk of this disease?

    No, although ACIP does not routinely recommend pneumococcal vaccine for healthy people of this age.

    Boosters and Revaccination (PPSV23)

    Could you briefly summarize the recommendations for PPSV23 revaccination?

    Revaccination 5 years after the first dose of PPSV23 is recommended for 1) children and adults younger than age 65 years at highest risk for serious pneumococcal infection or who are likely to have a rapid decline in antibody levels (see next Q&A) and 2) adults age 65 years and older who received their first dose for any indication when they were younger than age 65 years. Adults who receive PPSV23 at or after age 65 years should receive only a single dose.

    Which adults ages 19—64 years should receive a second dose of PPSV23?

    A second PPSV23 given 5 years after the first dose is recommended for people age 19 through 64 years who have functional or anatomic asplenia (including persons with sickle cell disease or splenectomy patients); chronic renal failure (including dialysis patients) or nephrotic syndrome; are immunocompromised, including those with HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy; are receiving immunosuppressive therapy (including long-term systemic corticosteroids or radiation therapy); or who have received a solid organ transplant.

    Do patients who were vaccinated with one or two doses of PPSV23 before age 65 need an additional dose of PPSV23 at age 65 or later?

    Yes. Patients who received PPSV23 for any indication at age 64 years or younger should receive an additional dose of PPSV23 vaccine at age 65 years or older if at least 5 years have elapsed since their previous PPSV23 dose.

    Should a healthy 75-year-old patient who was given PPSV at age 65 years be revaccinated?

    No. Adults who were first vaccinated at age 65 years or older need only one dose.

    Miscellaneous PPSV23 Issues

    I've heard pneumococcal polysaccharide vaccine (PPSV23) isn't very effective in older people. Should I still use it?

    Yes. PPSV23 vaccine is 60%-80% effective against invasive pneumococcal disease when it is given to immunocompetent people age 65 years and older or people with chronic illnesses. The vaccine is less effective in immunodeficient people. So, although PPSV23 is not as effective as some other vaccines, it can significantly lower the risk of serious pneumococcal disease and its complications in most recipients.

    My patient has had laboratory-confirmed pneumococcal pneumonia. Does he/she still need to be vaccinated with PPSV23?

    Yes. There are more than 90 known serotypes of pneumococcus (23 serotypes are in the current vaccine). Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, s/he should receive it even after one or more episodes of invasive pneumococcal disease.

    If influenza is recommended for healthcare workers to protect high-risk patients from getting influenza, why isn't the pneumococcal polysaccharide vaccine also recommended?

    Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than nasopharyngeal colonization with the organism. When you're giving influenza vaccine to your patients in the fall, don't forget to assess their need for pneumococcal vaccine as well as all other vaccines.

    Scheduling and Documenting Vaccines

    During an office visit, can a healthcare provider administer PCV13 and PPSV23 to an adult patient who needs both vaccines but who has had neither? If not, what is the recommended interval between doses?

    PCV13 and PPSV23 should not be given at the same visit. Patients who need both PCV13 and PPSV23 and who have received neither should receive PCV13 first, followed by a dose of PPSV23 at least 8 weeks later. If a second PPSV23 dose is recommended, it should be administered at least 5 years after the first PPSV23 dose.

    Rather than giving pneumococcal conjugate vaccine (PCV13) first and waiting 8 weeks to give PPSV as recommended for an immunocompromised child (2 years or older) or adult patient, we inadvertently gave both vaccines at the same visit. We are looking for guidance.

    When these two vaccines are given simultaneously, each probably affects the other detrimentally. The risk of diminished responsiveness (which is "caused" by PPSV23, not PCV13) means that you should count the PPSV23 dose as valid for adults, and repeat the PCV13 dose 1 year after the PPSV23 dose was administered. You should count the PPSV23 dose as valid for children, and repeat the PCV13 dose 8 weeks after the PPSV23 dose was administered and complete the series as age appropriate.

    What is the recommended interval between doses for adult patients who have already received one dose of PPSV23 and now need PCV13?

    For patients who have already had one or more doses of PPSV23, it is recommended to wait 1 year or more after PPSV23 before administering PCV13. If the patient is recommended to receive a second dose of PPSV23, delay that second PPSV23 dose for 8 weeks or more following PCV13 and 5 years or more following the first dose of PPSV23.

    If patients who are in a recommended risk group for PPSV23 or PCV13 aren't sure if they have previously received these vaccines, should healthcare providers vaccinate them?

    Yes. If patients do not have a documented vaccination history for these two vaccines and their records are not readily obtainable, you should administer the recommended doses. Extra doses will not cause harm to the patient.

    We just gave PPSV23 to a 66-year-old patient who is newly diagnosed with a medical condition that places him at increased risk for pneumococcal disease and its complications. Should we give him a second dose in 5 years because of his underlying medical condition?

    No. People who are first vaccinated with PPSV23 at age 65 years or older should receive only one dose, regardless of any underlying medical condition they might have.

    When should I vaccinate children or adults who are planning to have either a cochlear implant or elective splenectomy?

    It is preferable that the person planning to have the procedure have antibody to pneumococcus at the time of the surgery; if possible, administer the appropriate vaccine prior to the splenectomy or cochlear implant. Children 2 through 71 months of age should continue to receive PCV13 vaccine according to the schedule above. If the procedure is done on an emergency basis, vaccinate as soon as possible according to the routine schedule. Administer a dose of PPSV23 to all patients with an interval of at least 8 weeks from the previous dose of PCV13.

    How should we administer both pneumococcal vaccines (PCV13 and PPSV23) to our high risk pediatric patients?

    All children with risk factors for pneumococcal disease or its complications should be vaccinated with PPSV beginning at age 2 years. If they are age-eligible and are due for a dose of PCV13, give that one first and then wait 8 weeks before giving PPSV. For more information on vaccination of high risk pediatric patients, see pages 26—27 of the ACIP statement at

    Some physicians in our area order PPSV23 every 5 years for their patients. Is this correct?

    No. Only certain high-risk people who were vaccinated when younger than age 65 years will need a second dose 5 years later. At age 65 years, all adults (including people vaccinated when younger) will need to be vaccinated.

    Can we vaccinate a 2-year-old boy with functional or anatomic asplenia against meningococcal disease if he has not completed a series of PCV13?

    You should first be certain that he is up to date with PCV13 vaccine before you vaccinate him with MCV4. If you are going to give him MCV4-D (Menactra; sanofi pasteur), you need to wait at least 4 weeks after he completes the PCV13 series before giving him the MCV4-D. There is no similar space consideration if MCV4-CRM (Menveo; Novartis) is used; it may be given simultaneously with PCV13 or at any interval since receipt of PCV13.

    Can I give other vaccines at the same time I give either PCV13 or PPSV23 to a patient?

    Yes, with several exceptions. PPSV23 and PCV13 are both inactivated vaccines, which means you can give all other recommended vaccines at the same visit (using separate syringes) or at any later time with no waiting period following the vaccination. Here are the exceptions:

    a.You cannot give both PCV13 and PPSV23 at the same time. (Read next Q&A)

    b.If the person is a candidate for both meningococcal conjugate vaccine (MCV4) and PCV13, observe these rules:

    •If using MCV4-D (Menactra by sanofi), you should give PCV13 first with a 4 week separation between the final dose of PCV13 and MCV4-D.

    •If using MCV4-CRM (Menveo by Novartis): give both products simultaneously or at any other interval

    What intervals should be observed between doses of PCV13 and PPSV23 for those children and adults who are recommended to receive both vaccines?

    In these situations, give PCV13 first followed by PPSV23 in 8 weeks. For adults age 19 years and older who have received one or more doses of PPSV23 previously, wait 1 year before giving PCV13 to avoid interference between the 2 vaccines. For children age 2 through 18 years who have not received PCV13 but who have received one or more doses of PPSV23 previously, wait 8 weeks before giving PCV13.

    The Zostavax vaccine (Merck) package insert says that Zostavax should not be given simultaneously with pneumococcal polysaccharide vaccine (PPSV23). What does ACIP say about this?

    ACIP has not changed its recommendation on the simultaneous administration of these two vaccines (i.e., they can be given at the same time or any time before or after each other).

    Administering Vaccines

    What route and needle length is recommended for administration of pneumococcal polysaccharide vaccine?

    Pneumococcal polysaccharide vaccine may be given either by intramuscular (IM) or subcutaneous (SC) injection. When administration is IM, choose needle length appropriate to the person's age and body mass: toddlers age 2 yrs: 1–1¼" (anterolateral thigh) or ⅝–1" (deltoid muscle); children ages 3–4 yrs: ⅝–1" (deltoid) or 1–1¼" (anterolateral thigh); adults, a 1–1½" needle. A ⅝" needle may be used in toddlers and children and for adult patients weighing less than 130 lbs (60 kg) for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle. When administration of PPSV23 is SC, a ⅝" needle is recommended.

    What route and needle length should we use for administration of pneumococcal conjugate vaccine (PCV13)?

    Pneumococcal conjugate vaccine (PCV13) should be administered by the intramuscular (IM) route. Choose needle length appropriate to the person's age and body mass: infants younger than age 12 months: 1"; toddlers 1–2 yrs: 1–1¼" (anterolateral thigh) or ⅝–1" (deltoid muscle); children ages 3–4 yrs: ⅝–1" (deltoid) or 1–1¼" (anterolateral thigh); adults, a 1–1½" needle. A ⅝" needle may be used in toddlers and children and for adult patients weighing less than 130 lbs (60 kg) for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle.

    Vaccination Strategies

    We have begun a more aggressive approach to vaccinating our high-risk patients against pneumococcal disease. Do you have any suggestions on how we can improve our system?

    Congratulations on your efforts to increase your clinic's vaccination rates against this serious and deadly disease. Health experts have found that influenza predisposes individuals to bacterial community-acquired pneumonia, and studies have shown that this is heightened during influenza pandemics. In June 2009, CDC issued interim guidance for use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in preparation for the circulation of the pandemic H1N1 virus. Though the guidance does not change the groups indicated for PPSV23 and/or PCV13 vaccination, it does remind providers that many at-risk people younger than age 65 years and many people who are age 65 and older have not yet been vaccinated and they need to be.

  • My arm always feels like it's been punched hard for a few days after the jab. They usually warn that you may have flu like symptoms.

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