Pneumococcal vaccination - useful for which risk groups?

During the corona pandemic, there has been a shortage of pneumococcal vaccine supply in Switzerland. Therefore, a replacement vaccination recommendation has been issued. Infant vaccination coverage has led to a significant decrease in severe pneumococcal disease. Vaccination is still strongly recommended for this risk group. In second priority, persons with certain underlying diseases can be vaccinated regardless of age.

The information platform for vaccination issues in Switzerland (Infovac) recommends vaccination against pneumococcus with Prevenar13® for infants from 2 months to 5 years of age to protect against pneumococcal diseases such as meningitis, pneumonia, and sepsis [1]. Depending on the age of the child, 1 to 3 doses are required. Second priority vaccination with 1 dose of Prevenar13® is recommended for individuals at increased risk for invasive pneumococcal infection due to certain underlying conditions, regardless of age. The Swiss Vaccination Plan shows the diseases to which this applies [9]. In order to continue to provide care to the most at-risk groups in Switzerland, adherence to the indications recommended by the Federal Commission on Immunization (EKIF) and the Federal Office of Public Health (FOPH) is essential [9].

Increased demand leads to supply bottlenecks

A shortage of pneumococcal vaccines has been reported in Switzerland in connection with the COVID-19 pandemic [2,3]. EKIF and BAG have therefore published temporary replacement recommendations for the use of the vaccine Prevenar 13® (box). This points out that the vaccine is available, but only in limited supply. Therefore, priority should be given to vaccinating young children to prevent invasive pneumococcal disease, which is common and dangerous in these age groups, and secondarily to other patients at increased risk of pneumococcal infection due to chronic disease. In Switzerland, the procedure for lifting replacement vaccination recommendations is coordinated with the Federal Office for National Economic Supply [2].

Temporary substitute recommendation for pneumococcal vaccination.

The replacement vaccination recommendation proposes the following prioritization (information status: 10/03/21) [5]: “The Federal Office of Public Health (FOPH) and the Federal Commission on Immunization (ECIF) recommend that, as long as there is limited availability, first priority be given to vaccinating all infants at 2, 4, and 12 months of age. This corresponds to the basic pneumococcal vaccination recommended in the 2020 Vaccination Plan, with second priority to vaccinate individuals in the defined risk groups for invasive pneumococcal infection, determined on the basis of predisposing underlying diseases, with one dose of Prevenar13®. Vaccination in at-risk individuals (children >5 years of age and adults) consists of a single dose; no booster vaccinations are indicated. There is no vaccination indication for individuals outside of these two indication groups.”

Prevenar13® has a high efficacy against pneumococci

Statistical data show that the number of invasive pneumococcal cases has decreased over the years and this decrease is correlated with increasing pneumococcal vaccination coverage [4]. The rate of disease decreased most in the under-2 and 2- to 4-year-old age groups. The 13-valent vaccine (Prevenar13®) used in Switzerland since 2011 protects against a total of 13 pneumococcal species. These are responsible for 75-90% of all severe illnesses in infants. The pneumococcal conjugate vaccine has a very high efficacy (>95%), was developed specifically for infants, and is generally well tolerated [1]. Some unpleasant but harmless side effects, such as fever or local reactions (swelling, pain, and redness), are out of proportion to the benefits of pneumococcal vaccination. Severe side effects after vaccination are extremely rare (1:100,000 to 1:1,000,000).

Pneumococcal vaccination fails to prevent severe COVID-19 progression

In the context of current supply shortages, the FOPH points out that vaccination with Prevenar13^® while very effective in protecting against pneumococci, cannot prevent a severe course of COVID-19 [6]: “Such a course develops not because of secondary bacterial infections caused by pneumococci, but in the context of pulmonary and systemic inflammatory responses caused by the SARS-CoV-2 virus.” The Bavarian State Office for Health and Food Safety (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit), based on the Robert Koch Institute (RKI), has announced that full vaccination protection is important during the coronal pandemic, especially for people at risk with certain previous illnesses [7,9]. Pneumococcal vaccination protects against pneumonia caused by pneumococci, which stresses and weakens the immune system and the lungs, thus also promoting further infections, such as with the new coronavirus SARS-CoV-2. In addition, pneumococcal disease may require patients to be cared for in a hospital or intensive care unit. The vaccination recommendations in Germany are not completely congruent with those in Switzerland.

Literature:

Infovac.ch: pneumococci, 10/14/20, www.infovac.ch, (last accessed 03/10/2021).
EKIF: Minutes of the 81st Plenary Session. 16.09.2020 (last call 10.03.2021)
FOPH: Vaccination during the COVID 19 pandemic. Status: 06.04.2020, (last call 10.03.2021)
Infovac.ch: Invasive Pneumococcal Diseases 2013-2017, www.infovac.ch, (last accessed 03/10/2021).
BAG: Replacement recommendations: Prevenar13®: limited availability As of 03/20/2020, www.bag.admin.ch, (last accessed 03/10/2021).
BAG: Coronavirus: frequently asked questions (FAQ) www.bag.admin.ch, (last accessed 10.03.2021).
Bavarian State Office for Health and Food Safety (LGL), www.lgl.bayern.de/gesundheit, (last accessed 03/10/2021).
RKI: Epidemiological Bulletin 47/2020, Nov. 19, 2020, www.rki.de, (last accessed Mar. 10, 2021).
FOPH: Swiss Vaccination Plan 2020,
www.bag.admin.ch (last call 03/10/2021)