Introduction

The pneumococcal vaccination, also known as the pneumo jab, provides protection against pneumococcal infections.

Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae, which is sometimes referred to as the pneumococcus bacterium. There are many different strains (types) of the bacterium that can cause a number of 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

At-risk groups
A pneumococcal infection can affect anyone. However, some groups of people have a higher risk of the infection developing into a serious health condition. These include:

• children who are under two years of age
• adults who are 65 years of age or over
• children and adults with certain chronic (long-term) health conditions, such as a serious heart or kidney condition

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 of age as part of the childhood
• vaccination programme pneumococcal polysaccharide vaccine (PPV): this is given to people who are 65 years of age or over, and people at high risk Over 90 different strains of the pneumococcal bacterium have been identified, with 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.

Why Pneumococcal Vaccination is Used

The pneumococcal vaccination prevents pneumococcal infections, which can lead to very serious health conditions. In some cases, severe pneumococcal infections can lead to death.

How infections spread
Pneumococcal infections are easily spread from person to person, either by close or prolonged contact with someone who has the infection.

The pneumococcal bacteria are present in tiny droplets that are expelled when someone who is infected breathes, coughs or sneezes. If you breathe in these droplets, you will 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 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 two 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).

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 of people are offered a pneumococcal vaccination.

When Pneumococcal Vaccination Should be 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 that are usually given at:

• two months of age
• four months of age
• 13 months of age

For more information about the childhood vaccination schedule, see the Vaccination checklist.

If a child under five years of age 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 years of age 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 who are 2-64 years of age should have the PPV if they are at higher risk of developing a pneumococcal infection than the general population. Children up to five years of age who are at high risk may also need to have 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 that is 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 just once. In most adults, this is enough to provide protection 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 that you or your child has not been fully vaccinated. You should speak to your doctor about completing the vaccination programme.

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

If your child is over one and under two years of age 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 and under five years of age 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 doctor for further advice.

Side Effects of Pneumococcal Vaccination

The pneumococcal vaccinations are considered very safe and rarely cause problems. You cannot catch a pneumococcal infection from the injection because the vaccine does not contain 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 very rare cases, people can react badly to the vaccine and develop serious side effects. If you develop any unusual symptoms after having the vaccination, you should call your doctor immediately.