What are the prevention and treatment options for pneumococcal disease?

Prevention and Treatment Options for Pneumococcal Disease

Pneumococcal disease prevention requires vaccination of high-risk groups with either pneumococcal polysaccharide vaccine (PPSV23) or pneumococcal conjugate vaccines (PCVs), while treatment involves appropriate antibiotic therapy based on susceptibility patterns. 1

Prevention Strategies

Vaccination Recommendations

• All persons aged ≥65 years should receive pneumococcal vaccination to prevent invasive pneumococcal disease 1
• Immunocompetent persons aged ≥2 years with chronic illnesses that increase risk for pneumococcal disease should be vaccinated 1
• Persons aged ≥2 years with functional or anatomic asplenia require vaccination due to exceptionally high risk for severe pneumococcal infection 1
• Persons aged ≥2 years living in high-risk environments should receive pneumococcal vaccination 1
• Immunocompromised persons aged ≥2 years at high risk for infection should be vaccinated 1
• The most recent recommendations (2024) include a single dose of pneumococcal conjugate vaccine for all PCV-naïve adults aged ≥50 years 2

Vaccine Types

• 23-valent pneumococcal polysaccharide vaccine (PPSV23) is effective against invasive bacteremic disease but less effective against other pneumococcal infections 1, 3
• Pneumococcal conjugate vaccines (PCVs) provide improved immunogenicity and potentially better protective efficacy, especially in young children 1
• Conjugate vaccines may reduce nasopharyngeal carriage of pneumococcal serotypes included in the vaccine, potentially reducing transmission and disease incidence 1
• Current conjugate vaccine options include PCV20, PCV21, and PCV15 (which requires follow-up with PPSV23) 2

Revaccination Guidelines

• Routine revaccination of immunocompetent persons is not recommended 1
• Revaccination once is recommended for highest-risk individuals if 5 years have elapsed since the first dose 1
• High-risk groups include those with functional/anatomic asplenia, HIV infection, leukemia, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or other immunosuppressive conditions 1
• Children at highest risk for severe pneumococcal infection may be revaccinated 3 years after the previous dose if they would be ≤10 years old at revaccination 1
• Adults ≥65 years should receive a second dose if they were vaccinated ≥5 years previously and were <65 years at primary vaccination 1

Chemoprophylaxis

• Daily oral penicillin prophylaxis is recommended for children with sickle cell disease, beginning before 4 months of age 1
• Oral penicillin G or V is recommended for prevention of pneumococcal disease in children with functional or anatomic asplenia 1, 4
• Antimicrobial prophylaxis may be particularly useful for asplenic children unlikely to respond to polysaccharide vaccine (e.g., those <2 years or receiving intensive chemotherapy) 1

Passive Immunization

• Intramuscular or intravenous immunoglobulin may prevent pneumococcal infection in children with congenital or acquired immunodeficiency diseases who have recurrent, serious bacterial infections 1, 4
• Patients must demonstrate impaired antibody response to pneumococcal vaccination before considering immunoglobulin replacement therapy 5

Treatment Options

Antibiotic Therapy

• Levofloxacin is indicated for treatment of community-acquired pneumonia due to Streptococcus pneumoniae, including multi-drug-resistant strains 6
• For pneumococcal pneumonia, treatment duration ranges from 5 days for community-acquired pneumonia with certain pathogens to 7-14 days for more complex cases 6
• Where Pseudomonas aeruginosa is a documented or presumptive pathogen alongside pneumococcus, combination therapy with an anti-pseudomonal β-lactam is recommended 6
• Appropriate culture and susceptibility testing should be performed before treatment to determine bacterial susceptibility to antibiotics 6

Implementation Strategies

• Pneumococcal vaccination should be offered during routine health visits for eligible individuals 1
• The time of influenza vaccine administration provides an opportunity to identify and vaccinate patients with pneumococcal vaccine 1
• Health-care providers in facilities providing episodic or acute care should be familiar with pneumococcal vaccine recommendations 1
• Every patient should receive a vaccination record to avoid unnecessary doses, but vaccination should not be withheld if records are unavailable 1, 4

Common Pitfalls to Avoid

• Withholding vaccination in patients with uncertain vaccination history (rely on verbal history if records are unavailable) 1, 4
• Failing to recognize high-risk groups who need pneumococcal vaccination 1, 7
• Administering unnecessary revaccination to immunocompetent persons 1
• Neglecting to consider pneumococcal vaccination during influenza vaccination visits 1, 8
• Initiating treatment without appropriate culture and susceptibility testing, especially given increasing antimicrobial resistance 6