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Slide 20

Pneumococcal vaccine is recommended for all those aged 65 years and over, as well as all those aged over 2 months in the following clinical risk groups (with examples, decision based on clinical judgement): 1. Asplenia or dysfunction of the spleen: This also includes conditions such as homozygous sickle cell disease and coeliac disease that may lead to splenic dysfunction. 2. Chronic respiratory disease: This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Asthma is NOT an indication, unless so severe as to require continuous or frequently repeated use of systemic steroids (as defined in the immunosuppression section). Children with respiratory conditions caused by aspiration, or a neuromuscular disease (e.g. cerebral palsy) with a risk of aspiration. 3. Chronic heart disease: This includes those requiring regular medication and/or follow up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure. 4. Chronic renal disease: Including nephrotic syndrome, chronic renal failure, renal transplantation. 5. Chronic liver disease: Including cirrhosis. 6. Diabetes: Diabetes mellitus requiring insulin or oral hypoglycaemic drugs. 7. Immunosuppression: Due to disease or treatment. Including asplenia or splenic dysfunction, HIV infection at all stages. Patients undergoing chemotherapy leading to immunosuppression. Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mgs or more per day (any age) or for children under 20kgs a dose of 1mg or more per kg per day. However, some immunocompromised patients may have a sub optimal immunological response to the vaccine. 8. Individuals with cochlear implants. 9. Individuals with the potential for cerebrospinal fluid leaks: Including cerebrospinal fluid shunts and other conditions where leakage of cerebrospinal fluid can occur. 10. Children under 5 years of age who have previously had invasive pneumococcal disease: e.g. children who have previously had pneumococcal meningitis or pneumococcal bacteraemia.

Reference
Chief Medical Officer (March 31st 2005). www.doh.gov.uk/cmo/index

Slide 21

Pneumococcal vaccine is recommended for all those aged 65 years and over, as well as all those aged over 2 months in the following clinical risk groups (with examples, decision based on clinical judgement): 1. Asplenia or dysfunction of the spleen: This also includes conditions such as homozygous sickle cell disease and coeliac disease that may lead to splenic dysfunction. 2. Chronic respiratory disease: This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Asthma is NOT an indication, unless so severe as to require continuous or frequently repeated use of systemic steroids (as defined in the immunosuppression section). Children with respiratory conditions caused by aspiration, or a neuromuscular disease (e.g. cerebral palsy) with a risk of aspiration. 3. Chronic heart disease: This includes those requiring regular medication and/or follow up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure. 4. Chronic renal disease: Including nephrotic syndrome, chronic renal failure, renal transplantation. 5. Chronic liver disease: Including cirrhosis. 6. Diabetes: Diabetes mellitus requiring insulin or oral hypoglycaemic drugs. 7. Immunosuppression: Due to disease or treatment. Including asplenia or splenic dysfunction, HIV infection at all stages. Patients undergoing chemotherapy leading to immunosuppression. Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mgs or more per day (any age) or for children under 20kgs a dose of 1mg or more per kg per day. However, some immunocompromised patients may have a sub optimal immunological response to the vaccine. 8. Individuals with cochlear implants. 9. Individuals with the potential for cerebrospinal fluid leaks: Including cerebrospinal fluid shunts and other conditions where leakage of cerebrospinal fluid can occur. 10. Children under 5 years of age who have previously had invasive pneumococcal disease: e.g. children who have previously had pneumococcal meningitis or pneumococcal bacteraemia.

Reference
Chief Medical Officer (March 31st 2005). www.doh.gov.uk/cmo/index

Slide 22

For individuals aged five years and above, including those aged 65 years and over, a single dose of 23-valent pneumococcal polysaccharide vaccine (Pneumovax® II) is recommended. The vaccine can be offered throughout the year. Please note that re-immunisation with this vaccine is not currently recommended for most people. Re-immunisation is only recommended after 5 years for people whose antibody levels are likely to have declined more rapidly, e.g. those with no spleen, with splenic dysfunction or with nephrotic syndrome.

Children aged 2 months to under 5 years of age should be vaccinated according to the schedule below: Infants who commence immunisation between 2 months and less than six months of age should be given three doses of pneumococcal conjugate vaccine (Prevenar) with an interval of one month between doses. A fourth dose should be given after the first birthday.
Infants who commence immunisation aged six to under twelve months should be given two doses of pneumococcal conjugate vaccine (Prevenar) with an interval of one month between doses. A third dose should be given after the first birthday (and at least one month after the second dose). Children who commence immunisation aged 12 to 60 months should have two doses of pneumococcal conjugate vaccine (Prevenar) with an interval of two months between doses.
It is recommended that all three of the above groups also receive a single dose of the 23-valent polysaccharide vaccine (Pneumovax® II) after the age of two years (with a period of at least two months from the last dose of conjugate vaccine given).

Reference
Chief Medical Officer (March 31st 2005). www.doh.gov.uk/cmo/index


Slide 23 & 24

At their meeting in October 2004, the Joint Committee on Vaccination and Immunisation agreed in principle to the introduction of pneumococcal vaccine for all children.
Any introduction is subject to further assessment of the number and timing of doses required to provide protection, the price of the vaccine, and assurances that supply of the vaccine can be guaranteed.

Reference
www.advisorybodies.doh.gov.uk/jcvi/mins011004.html, accessed 04/01/2005


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