Pneumococcal vaccination

and Martina Feichter, medical editor and biologist and Florian Tiefenböck, doctor

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

A pneumococcal vaccination protects against pneumococcal infections. These bacteria can cause meningitis or pneumonia, for example. Such illnesses can be serious and even fatal - especially in certain age groups and with certain previous illnesses. Read here when and for whom the pneumococcal vaccination is useful and what side effects it can have.

Pneumococcal vaccination: who should be vaccinated?

The pneumococcal vaccination is recommended as the standard vaccination for all infants and young children and for people aged 60 and over:

Children in the first two years of life are particularly at risk of developing a pneumococcal infection - the general recommendation for vaccination therefore applies to this age group.

Pneumococcal pneumonia is the most common cause of pneumonia in the elderly, if it is bacterial. The elderly are also particularly susceptible to severe pneumococcal disease. For this reason, the pneumococcal vaccination is also the standard vaccination for the age group 60 and over (= protective vaccination that is recommended for all or at least for all representatives of an age group).

In addition, the STIKO recommends vaccination against pneumococci as an indication vaccination for certain risk groups - i.e. for people who are particularly susceptible to (severe) pneumococcal disease, regardless of age. These risk patients include:

People with congenital or acquired immunodeficiency - either due to a disease (such as congenital immunodeficiency, HIV, missing or non-functional spleen) or medical treatment (e.g. immunosuppressive therapy for autoimmune diseases or after a transplant)
People with other chronic diseases such as chronic lung, heart, liver or kidney diseases (e.g. asthma, COPD, heart failure, liver or kidney failure), metabolic diseases (e.g. diabetes mellitus requiring treatment) or neurological diseases (such as seizure disorders)
People with an increased risk of meningitis due to a foreign body (e.g. cochlear implant) or special anatomical conditions (e.g. liquor fistula: a normally non-existent opening of the cerebrospinal fluid-filled cavities to the outside, e.g. after a head injury)
People who have an increased risk of illness through welding and cutting metals, for example, receive the pneumococcal vaccination for work-related reasons (welding or metal smoke promotes pneumonia. The vaccination can at least protect against pneumococcal pneumonia).

What are pneumococci?

Pneumococci are bacteria that can cause various diseases. These include, for example, pneumonia, sinusitis and otitis media.

So-called invasive pneumococcal diseases are particularly dangerous. The bacteria spread in otherwise sterile body fluids. In this way, for example, life-threatening meningitis (meningitis) or sepsis ("blood poisoning") caused by pneumococci can develop.

Pneumococci usually develop without complications in young, otherwise healthy people. Babies and toddlers in particular, as well as the elderly, can become seriously ill and even die from an invasive pneumococcal disease. People with previous illnesses or a weakened immune system are also at risk.

Types of Pneumococcal Vaccines

Inactivated vaccines are used for pneumococcal vaccination. They contain characteristic components (sugar compounds) from the bacterial shell. If the doctor has injected the pneumococcal vaccine, the immune system reacts by forming specific antibodies against these components (active vaccination). These antibodies also defend against the bacteria in the event of a "real" pneumococcal infection.

Pneumococcal Polysaccharide Vaccine (PPSV)

This type of vaccine has been available since the 1970s. The currently available PPSV contains the characteristic shell components of 23 different pneumococcal variants (subtypes, serotypes). This vaccine with the abbreviation PPSV23 is approved for children from two years of age.

Pneumococcal Conjugate Vaccine (PCV)

This type of vaccine is a recent development. Here the characteristic shell components of various pneumococcal serotypes are bound to a carrier substance (a protein). This improves the immune response and thus the effect of the vaccination. In Germany there are currently two pneumococcal conjugate vaccines on the market that can be injected from the age of six weeks:

PCV10: It protects against 10 different pneumococcal serotypes. PCV10 is approved for children up to five years of age.
PCV13: It offers more protection than the PCV10 vaccine because it is based on the envelope components of 13 pneumococcal serotypes. PCV13 is approved for all ages.

Pneumococcal vaccination: how often and when is vaccinated?

Pneumococcal vaccination in children

The pneumococcal vaccination is recommended by the Standing Vaccination Commission (STIKO) for all infants aged two months and over. The experts only recommend a pneumococcal conjugate vaccine (ideally PCV13) because the polysaccharide vaccine does not work sufficiently in children under two years of age.

Doctors usually give babies the pneumococcal vaccine along with other standard vaccines, at the same time as the six-fold vaccine for diphtheria, tetanus, hepatitis B, Haemophilus influenzae type B, whooping cough, and polio.

For adequate pneumococcal vaccination protection, the STIKO recommends three vaccinations:

The first vaccination against pneumococci at the age of two months
The second pneumococcal vaccination at the age of four months
The third pneumococcal vaccination at the earliest six months later (more precisely: between the ages of 11 and 14 months)

In premature babies - i.e. babies born before the 37th completed week of pregnancy (≤ 36 + 6 weeks of gestation) - an additional dose of the pneumococcal vaccine is useful for basic immunization. Experts recommend the above vaccination schedule with an additional pneumococcal vaccination at the age of three months.

Delayed pneumococcal vaccination (7-11 months)

If you missed the start of the vaccination series and the child receives the first vaccination at the earliest seven months, the specialist information recommends two vaccinations at least one month apart. A third pneumococcal vaccination then takes place in the course of the second year of life.

Vaccination in the second year of life

For children in the second year of life (i.e. older than 12 months and younger than 24 months) who have not yet been vaccinated against pneumococci, the vaccination can be made up with only two vaccine doses. There should be at least eight weeks between the two vaccination appointments.

2 + 1 vaccination schedule

In Austria or Switzerland, for example, experts recommend the so-called 2 + 1 vaccination scheme for pneumococci. The vaccination series does not begin until one month later, i.e. when the patient is three months old. A second vaccination follows at five months. The third vaccination is considered to be a “booster dose” that babies between 12 and 14 months of age receive. Ultimately, as in Germany, the children receive three vaccinations, but achieve pneumococcal vaccination a little later.

In Austria, for example, the 2 + 1 vaccination scheme also applies to the six-fold vaccine against diphtheria, pertussis, tetanus, polio, hepatitis B and Haemophilus influenzae. As with the pneumococcal vaccination, the vaccination series then begins at three months of age. The German STIKO recommends four vaccinations here. The Austrian Ministry of Health only recommends a 3 + 1 vaccination scheme in high-risk cases, such as premature babies.

Pneumococcal vaccination for people aged 60 and over

People who are 60 years or older and do not belong to any risk group (e.g. those with chronic lung or heart disease) receive the pneumococcal polysaccharide vaccine (PPSV23) once as a standard.

The effect of a single vaccination is limited. Nevertheless, the experts currently do not recommend any basic or routine pneumococcal booster vaccination because the vaccine mentioned has not yet been clearly approved for this. Only if the attending physician deems it sensible in individual cases - for example in the case of the chronically ill - will he refresh the pneumococcal vaccination (every six years).

Pneumococcal vaccination in risk groups

Children older than two years of age and healthy have a very low risk of developing severe pneumococcal disease. The experts therefore do not recommend a general booster or catch-up vaccination against pneumococci in these cases.

However, special recommendations for pneumococcal vaccination apply to people who have an increased risk of a severe pneumococcal disease due to a chronic illness, immunosuppressive therapy or their occupational activity.

The polysaccharide vaccine PPSV23 is only approved from the age of two.

People with immunodeficiency or immunosuppression

People who suffer from a congenital or acquired immunodeficiency or who are on immunosuppressive therapy receive a sequential vaccination:

The first pneumococcal vaccination is carried out with the conjugate vaccine PCV13.
After six to twelve months, the doctor vaccinates again, but now with the polysaccharide vaccine PPSV23. Because this only has a limited effect, the vaccination protection should be renewed every six years with PPSV23.

The vaccination should be given before the start of immunosuppressive therapy or before the planned removal of the spleen.

People with chronic illnesses

In the case of chronic diseases (such as cardiac insufficiency or asthma), the recommendations for pneumococcal vaccination are based on the age of the patient:

For children between two and 15 years of age, the experts recommend the sequential vaccination described above.
From the age of 16, doctors vaccinate with the polysaccharide vaccine (PPSV23). After at least six years they repeat the pneumococcal vaccination.

People at increased risk of meningitis

A cochlear implant increases the risk of meningitis caused by pneumococci, as does a CSF fistula. Therefore, those affected receive the sequential vaccination against pneumococci described above (attention: PPSV23 only from the age of two). Every six years, doctors refresh the vaccination with PPSV23.

In the case of cochlear implants, doctors will give the vaccine before the implant is inserted whenever possible.

Occupational pneumococcal vaccination

Anyone who has an increased risk of (severe) pneumococcal diseases due to their work should be vaccinated against pneumococci with the polysaccharide vaccine PPSV23. As long as this risk persists (i.e. the corresponding work is being carried out), those affected repeat the vaccination at least every six years.

Pneumococcal vaccination: side effects

The pneumococcal vaccination often causes reactions at the injection site (reddening, swelling, pain). But it also shows that the vaccine activates the immune system.

In addition, slight general symptoms such as fever, headache, fatigue, muscle and joint pain may occur in the first few days after the pneumococcal vaccination. In babies and toddlers, general vaccination reactions include fever, drowsiness, restless sleep or gastrointestinal complaints (such as diarrhea or less hunger).

All of these vaccine reactions usually subside after one to three days.

Pneumococcal vaccination rarely causes more serious side effects. For example, some people have an allergic reaction to the vaccine (for example, in the form of hives). The number of platelets in the blood, which contribute significantly to blood clotting, also very rarely falls.

Infants and young children who develop a fever after vaccination may develop febrile seizures. As a rule, however, it has no consequences. A short-term shock-like condition also rarely occurs after the pneumococcal vaccination: the muscle tension decreases and the child is not responsive. This so-called hypotonic-hyporesponsive episode (HHE) usually resolves itself quickly and without consequences.

Pneumococcal vaccination: cost

The Federal Joint Committee has included the STIKO recommendations on pneumococcal vaccination described above in the so-called protective vaccination guideline. The statutory health insurance pays for the pneumococcal vaccination for the named groups of people in the manner described.

So if, for example, the doctor gives your baby the recommended doses of the pneumococcal conjugate vaccine, your health insurance company will cover the costs. The pneumococcal vaccination for over 60-year-olds with PPSV23 or the sequential vaccination, for example in the case of congenital immunodeficiency, are covered by health insurance.

Vaccine in short supply: who really needs it?

In medical crises, such as the Sars-CoV-2 coronavirus pandemic, delivery bottlenecks can occur - including the pneumococcal vaccine. Delivery problems are not always the cause. The high demand can also limit availability.

At such times it is important that doctors can continue to vaccinate against pneumococci, especially at risk groups. Because you have an increased risk that pneumococcal disease will be severe and fatal.

If there are bottlenecks, the experts at the Robert Koch Institute recommend pneumococcal vaccination primarily for the following people:

Children from two months to two years: pneumococcal vaccination with the conjugate vaccine PCV13
Alternative vaccine (children from two months to two years): The 10-valent pneumococcal vaccine (PCV10) if the 13-valent vaccine is not available
Patients with immune deficiency: Pneumococcal vaccination with the polysaccharide vaccine PPSV23
Seniors from 70 years: PPSV23
Patients with chronic respiratory disease: PPSV23

If the pneumococcal vaccination is available again, the recommendations of the Standing Vaccination Commission continue to apply.

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