Pneumovax^®23 vaccine is not part of the routine immunisation schedule but is funded for children and adults with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule. The vaccine is available for purchase by people with a medical condition that is not listed on the Pharmaceutical Schedule.

Special groups

Pneumovax23 is recommended and funded as follows:

Up to two doses (as appropriate) for high-risk children aged 2 years to under 18 years, or up to three doses (as appropriate) for individuals aged 18 years or older in the following groups:

Children aged 2 years to under 5 years

• Cardiac disease with cyanosis or failure
• Cerebrospinal fluid leak
• Chronic pulmonary disease, including asthma treated with high-dose corticosteroid therapy
• Cochlear implant
• Corticosteroid therapy for more than two weeks and who are on an equivalent daily dosage of prednisone of 2 mg/kg per day or greater, or children who weigh more than 10 kg on a total daily dosage of 20 mg or greater
• Diabetes
• Down syndrome
• Functional asplenia
• HIV-positive
• Immunosuppressive therapy
• Intracranial shunt
• Nephrotic syndrome
• Pre-or post-splenectomy
• Pre-term infant born before 28 weeks gestation
• Primary immune deficiency
• Post-haematopoietic stem cell transplantation
• Post-solid organ transplantation
• Radiation therapy
• Renal failure

Children aged 5 years or older, and adults

• Cochlear implant
• Complement deficiency (acquired or inherited)
• Functional asplenia
• HIV-positive
• Post-haematopoietic stem cell transplantation
• Post-chemotherapy
• Pre- or post-splenectomy
• Pre- or post-solid organ transplantation
• Primary immunodeficiency
• Renal dialysis

For use in testing for primary immunodeficiency diseases, on the recommendation of an internal medicine physician or paediatrician.

N.B. Pneumovax23 should be administered at least 8 weeks after Prevenar13 (pneumococcal conjugate vaccine) is also funded for these groups.

Catch-up doses

Children from 2 years of age and adults can catch up missed doses of this vaccine.

Vaccine storage and preparation

No special considerations, store as per cold chain between 2°C to 8°C.

Administration

Pneumovax23 can be administered concurrently with all other vaccines except other pneumococcal vaccines e.g. Prevenar 13, Synflorix. Separate syringes and different injection sites should be used.

If re-immunisation is required a minimum of 5 years should be maintained between doses, to reduce the incidence of hyporesponsiveness to vaccine pneumococcal serotypes. A maximum of 3 doses are recommended in an adult lifetime.

Vaccine should not be given to:

• Infants and children under the age of 2 years (polysaccharide vaccines are unsuitable for children under two years of age as they are unable to mount protective response)
• Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or other pneumococcal containing vaccine, or a component of the vaccine
• Administration of Pneumovax23 should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

Pneumovax23 vaccination is T-cell independent and does not result in long lasting memory.

Adults respond better to Pneumovax23 than children. In adults antibodies decline 5–10 years after vaccination, this waning of immunity may faster in adults older than 60 years. The antibodies last around 3–5 years in children.

For some patients who are receiving immunosuppressive therapy and the elderly, antibody responses may not sufficient to protect against pneumococcal infection and impairment of future immune responses to pneumococcal antigens may occur. It is therefore recommended that high risk patients are vaccinated with Prevenar 13 at least 8 weeks prior to Pneumovax23 or Prevenar 13 is delayed for a year after Pneumovax23.

• Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
• Lyer AS, Ohtola JA, Westerink MA. Age-related immune response to pneumococcal polysaccharide vaccination: lessons for the clinic. Expert Rev Vaccines. 2015;14(1):85-97
• Leventer-Roberts M, Feldman BS, Brufman I, et al. Effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive disease and hospital-treated pneumonia among people aged ≤65 years: A retrospective case-control study. Clinical Infectious Diseases. 2015;60(10):1472-80
• Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged >65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR - Morbidity & Mortality Weekly Report. 2014;63(37):822-5