Pneumococcal polysaccharide vaccine PPV

The vaccine prevents meningitis, pneumonia, sepsis and middle-ear infections caused by pneumococcal bacteria.
Vaccine-preventable diseases

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To whom is a pneumococcal polysaccharide vaccine administered?

The pneumococcal polysaccharide vaccine can be used for boosters and additional vaccinations of persons who have received a pneumococcal conjugate vaccine and who are susceptible to certain serious pneumococcal diseases. 

It should thus be noted that a person usually needs to first receive the conjugate vaccine and only then, at the physician's discretion, the polysaccharide vaccine.

On a discretionary basis, the vaccine can be offered free of charge as part of the national vaccination programme

  • to stem cell transplant recipients
  • children aged over 2 but under 5 years in at-risk groups.

At the case-by-case discretion of the treating physician, the vaccine may be administered to

  • adults aged 65 and over
  • children aged 5 and over and adults in at-risk groups.

In these cases, the vaccine is paid for by the patient or the treatment provider.

Which vaccine is used and what does it contain? 

A 23-valent Pneumovax vaccine (PPV23) is used in the vaccination programme.

  • The vaccine does not contain live pathogens.
  • The active substance contains polysaccharides derived from 23 different types of pneumococcal bacteria.
  • The excipients are salt and purified water.
  • A small quantity of phenol is used as a preservative.

Dosage and schedule

The vaccine dose is 0.5 ml. A single dose is normally sufficient. 

It should be noted that, as a rule, the conjugate vaccine needs to be administered first, only then followed by the polysaccharide vaccine. 

See the Finnish Institute for Health and Welfare’s website for the schedules of the national vaccination programme and pneumococcal vaccinations for at-risk groups.

Revaccination

Revaccinations are not necessary. 

Many countries have had the practice of recommending revaccination after five years for persons aged over 5 with immunodeficiency disorders who have received a single dose of the pneumococcal polysaccharide vaccine. 

The routine administration of revaccinations is no longer recommended due to insufficient research evidence and potential reduction in antibody-producing B cells, or hyporesistance.

What are the contraindications and precautions associated with the vaccine?

The vaccine may not be administered to a person who has had a confirmed serious allergic reaction (anaphylaxis) following a previous dose of a PPV vaccine or a vaccine containing similar components.

The vaccination should be postponed if the recipient has a fever or febrile infection.

What are the benefits of pneumococcal polysaccharide vaccinations?

Many chronic illnesses increase the risk of serious pneumococcal infections or complications associated with them.

Splenectomy patients and those with reduced immune defence because of some other illness or its treatment have been a key target group for the PPV vaccine. The immune response to some components of the vaccine in certain patients with an immunodeficiency disorder has, however, been reduced.

In most observational studies, the effectiveness of PPV against an invasive disease has been moderate at individual level. 

Unlike in the case of the pneumococcal conjugate vaccine, no impact on pneumococcus carriage has been proven for PPV. Consequently, it does not indirectly cause changes in the serotype distribution.

PPV is less likely to be effective against blood-culture negative pneumonia than the conjugate vaccines. The duration of the protection is probably also relatively short.

Nevertheless, most recipients are likely to benefit from the vaccination.

What are the potential adverse effects of the pneumococcal polysaccharide vaccine?

This vaccine has been used for a long time, and it has been considered safe. 

Concerns have in recent years been expressed over the polysaccharide vaccine's potential to cause hyporesistance; no consensus on the clinical significance of this exists.

Local symptoms at the injection site are common, however, especially following revaccinations. They are usually mild and disappear in a few days without treatment. Vaccine recipients rarely develop a fever. 

The local reactions and generalised symptoms may be treated with fever and pain medications.

History of the vaccine in the national vaccination programme

Pneumococcal vaccinations for children aged under 5 years in at-risk groups were introduced as part of the national vaccination programme in 2009. At the physician's discretion, it has also been possible to administer a polysaccharide vaccine to them. 

The vaccine is also offered in the national programme following stem cell transplantation in which the patient's own stem cells were used.

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