Pneumococcal vaccination

Pneumococci are the most frequent bacterial agent of community-acquired pneumonia and are one of the most common vaccine-preventable causes of death worldwide. There is a polysaccharide vaccine that contains the capsular polysaccharides of 23 of the more than 90 known serotypes. PPV23 confers good protection against invasive pneumococcal infections but does not stimulate T cells and thus leaves no immunologic memory. It has limited efficacy in immunocompromised individuals. Initially for young children and later for adults, a 13 valent conjugate vaccine was licensed that covers fewer serotypes but leaves immunologic memory and mediates mucosal immunity, i.e. by eradicating healthy pneumococcal carriers, and thus has herd-protective effects. The German Standing Commission on Vaccination Practices (STIKO) currently recommends PPV23 for indication vaccination in various comorbidities and as standard vaccination for all above 60 years with repeat vaccination after 6 years at the earliest. Patients with immunosuppression, chronic renal failure or chronic liver failure should receive a sequential vaccination (first PCV13 followed by PPV23 after 6–12 months) due to the limited efficacy of PPV23 and their increased risk for infection.