A. Pneumococcal Infection
1. What is pneumococcal infection?
Pneumococcal infection represents a wide range of diseases caused by the bacterium Streptococcus pneumoniae (or more commonly referred as pneumococcus). While pneumococcus is a common cause of mild illnesses such as sinus or middle ear infections, it may also cause severe or even life-threatening invasive pneumococcal diseases (IPD) such as bacteremic pneumonia, sepsis, and meningitis. The outcomes for IPD are usually more severe among young children and elderly persons.
2. What is Streptococcus pneumoniae / pneumococcus?
Streptococcus pneumoniae (pneumococcus) is the causative agent of pneumococcal infections. It is a Gram-positive bacterium encapsulated with polysaccharides. The difference in the composition of capsular polysaccharides constitutes to at least 100 different serotypes of pneumococci identified thus far.
3. How does individual acquire pneumococcal infections? What is the route of transmission for pneumococci?
Pneumococci are carried on human bodies. They are present in the upper respiratory tracts even in some healthy carriers. The bacteria can be transmitted via spread of droplet, direct oral contact or indirect contact with articles soiled with respiratory discharges.
4. What is the incidence rate of invasive pneumococcal diseases (IPD) in Hong Kong?
In Hong Kong, the annual incidence of IPD ranged from 0.34 to 2.54 per 100,000 from 2018 to 2022. IPD was more commonly found among children aged 2 to 4 years and elderly aged 65 years or above, while serotype 3 was the predominant serotype causing IPD accounting for about half of all cases recorded during 2015 to 2019.
5. How can pneumococcal infections be treated?
The treatment of pneumococcal infections usually involves the use of antibiotic(s). But there is a problem of increasing resistance of the bacterium to antibiotics, which makes prevention of pneumococcal infections important
6. Is a person previously contracted with pneumococcal disease immune from future invasive pneumococcal diseases?
As there are over 100 serotypes of pneumococcus, previous infection of a serotype of pneumococcus may not confer immunity to other serotypes of pneumococcus.
7. How can invasive pneumococcal diseases be prevented?
Pneumococcal vaccination is one of the most effective means of preventing pneumococcal diseases. The public should also maintain good personal and environmental hygiene practices, balanced diet, regular exercise, adequate rest, and no smoking.
8. What is the relationship between influenza and pneumococcal infection?
Influenza predisposes individuals to community-acquired bacterial pneumonia. Secondary bacterial pneumonia has been an important cause of morbidity and mortality for those infected with influenza.
B. Pneumococcal Vaccine
1. Are there different types of pneumococcal vaccines?
There are different types of pneumococcal vaccines available in the market, such as 13-valent pneumococcal conjugate vaccine (PCV13), 15-valent pneumococcal conjugate vaccine (PCV15), 20-valent pneumococcal conjugate vaccine (PCV20) and 23-valent pneumococcal polysaccharide vaccine (23vPPV). Pneumococcal conjugate vaccines (i.e. PCV13, PCV15 and PCV20) contain pneumococcal capsular polysaccharides conjugated to carrier proteins, while 23vPPV contains pneumococcal capsular polysaccharides for 23 pneumococci serotypes.
2. Who should get pneumococcal vaccines?
The Scientific Committee on Vaccine Preventable Diseases (SCVPD) recommends children to receive 15-valent pneumococcal conjugate vaccines (PCV15), with 2 primary doses given at 2 and 4 months followed by a booster dose at 12 months, under the Hong Kong Childhood Immunisation Programme (HKCIP).
Under the Government’s Pneumococcal Vaccination Programme, persons aged 65 years or above without high risk conditions* are eligible to receive one dose of 23-valent pneumococcal conjugate vaccine (23vPPV). Persons with high risk conditions* are eligible to receive one dose of PCV15, followed by one dose of 23vPPV one year after.
For individuals not eligible for the Government’s Pneumococcal Vaccination Programme, they may choose to receive any locally registered pneumococcal vaccine to protect themselves against invasive pneumococcal disease following the manufacturer’s recommendations and upon discussion with healthcare professionals.
*High-risk conditions include:
3. Why is it necessary for elders to receive both influenza vaccine and pneumococcal vaccines?
Secondary bacterial pneumonia is an important cause of morbidity and mortality for those infected with influenza. Data from a local study shows that dual vaccination with influenza vaccine and pneumococcal vaccines can lower the risk of hospitalisation and mortality among elderly people.
4. Can pneumococcal vaccines be received together with seasonal influenza vaccine?
Yes. Pneumococcal vaccines can be given together with seasonal influenza vaccine, but they should be administered with a different syringe and at a different injection site.
5. Can pneumococcal vaccine be given together with COVID-19 vaccine?
COVID-19 vaccines can be co-administered with, or at any time before or after, pneumococcal vaccines under informed consent.
6. Can pneumococcal vaccines be given prior to / after certain medical procedures?
For individuals who will undergo elective splenectomy, pneumococcal vaccines should be given at least 2 weeks before the procedures if possible. Pneumococcal vaccines should ideally be given before or after completion of chemotherapy/radiotherapy but they may still be given as clinically indicated during long term use of chemotherapeutic agents.
7. What are the possible adverse reactions following 23-valent pneumococcal polysaccharide vaccine administration (23vPPV)?
Common adverse reactions include slight swelling and tenderness at the injection site shortly following injection but most resolve within two days. Fever, muscle aches or more severe local reactions are uncommon.
Receiving vaccination is safe. If you experience persistent fever, severe allergic reactions (e.g. difficulty in breathing, swelling of the lips or tongue, or hives, etc.) or other adverse events after vaccination, please consult a doctor immediately.
8. What are the possible adverse reactions following 15-valent pneumococcal conjugate vaccine (PCV15) administration?
The most common adverse reactions after PCV15 administration observed in children less than 2 years old are fever, irritability, somnolence and injection-site pain, while injection-site pain, fatigue, myalgia and headache are the most common in adults.
Receiving vaccination is safe. If you experience persistent fever, severe allergic reactions (e.g. difficulty in breathing, swelling of the lips or tongue, or hives, etc.) or other adverse events after vaccination, please consult a doctor immediately.
9. Who are not suitable to receive pneumococcal vaccines?
Severe allergic reaction following a prior dose of pneumococcal vaccine or to the vaccine component or any diphtheria toxoid-containing vaccine is a contraindication to further doses of vaccine.
10. Can individual receive pneumococcal vaccines if they are not feeling well on the day of vaccination?
Minor illnesses such as upper respiratory tract infections are not contraindications to vaccination. Vaccination may also be deferred until symptoms subside in case of any worry.
C. Vaccination Arrangement of Pneumococcal Vaccination Programme for Elderly
1.What is the vaccination arrangement for elderly aged 65 years or above under the Government’s Pneumococcal Vaccination Programme?
The Government's Pneumococcal Vaccination Programme provides free or subsidised pneumoccal vaccination for persons aged 65 years or above. Persons without high risk conditions* are eligible to receive one dose of 23-valent pneumococcal conjugate vaccine (23vPPV). Persons with high risk conditions* are eligible to receive one dose of 15-valent pneumococcal conjugate vaccine (PCV15), followed by one dose of 23vPPV one year after.
*High-risk conditions include:
2. How can elderly confirm their previous pneumococcal vaccination history?
Elderly should try to find out all their previous vaccination records/cards and bring them to their attending doctor. Vaccination records are important reference to doctors before they can provide appropriate vaccination. Else, elderly should return to the clinics where they received previous vaccinations to trace their records. If they still cannot trace the records, they should tell their doctors their vaccination history as far as they can recall so that their doctor can make assessment and provide them with the necessary vaccination.
3. If elderly with high-risk conditions are not sure if they have previously received pneumococcal vaccine (type and time), should they still go for vaccination?
Yes. If elderly with high-risk conditions do not have a documented vaccination history (e.g. vaccination card and electronic record) for pneumococcal vaccine, they should trace record from clinics receiving previous dose of pneumococcal vaccine. If the elderly still cannot trace the record and cannot recall the type and time of vaccination, they should still receive the recommended doses, i.e. a single dose of PCV15 followed by a dose of 23vPPV one year later.
Source: Centre for Health Protection https://www.chp.gov.hk/en/features/100770.html
last update：3 September 2024
(20240930)
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