13 responses to “Clearing up the confusion around pneumococcal vaccines”

  1. One comment I heard in the past was that Pneumovax 23 was better at preventing sepsis and meningitis and Prebner 13 was more specific for the strains that caused pneumonia. Is this true?

  2. I believe that I may have acquired alopecia from this vaccine. I had 2 shots 5 years apart as recommended by my GP. Personally it was a great trade off from normally having pneumonia yearly, my question will satisfy my curiosity. Thanks very much.

  3. This was a very helpful review of a confusing topic. Thank you!

  4. Thank you for your comments!
    Ronald Davidson – Yes, Pneu-P-23 contains the strains that are implicated in most of the cases of pneumococcal sepsis and meningitis (IPD) in Canada, but it also contains all the strains except one that are included in Pneu-C-13.
    The Pneu-C-13 vaccine is more immunogenic, but is only effective for prevention of pneumococcal disease due to the strains contained in that vaccine. When it was developed over a decade ago, there was a higher incidence of Community Acquired Pneumonia due to these 13 strains, but currently 4% or less of all cause pneumonia is due to these particular Pneu-C-13 strains due to herd immunity provided by childhood vaccination programs reducing prevalence of these strains in the community. Neither vaccine is particularly effective at preventing adult pneumonia these days!

    Lori Marmoreo – I’m sorry to hear that you have experienced alopecia. I’m not aware of any published literature on pneu-P-23 vaccine causing alopecia, and reviewed the product monograph to this end. I am aware that some vaccines have been anecdotally associated with hair loss and one can find online commentary, but it is not a side effect usually attributed to immunizations. I will keep my eyes on the literature now, however.

  5. very helpful & timely review – pneumococcal 23 in healthy adults 65y plus booster in 5y as per provincial coverage & guidelines thx

  6. I recently tuned in to a webinar on the Pneumococcal vaccines in Canada and the differences between what Health Canada and the US CDC’s positions on Pneumo-C-13 in immunocompetent adults >65yrs. I am still left with some questions from your article and this webinar.

    There was an inference in this webinar that the Pediatric regimens of P-13 are different in Canada than the US, and that we in Canada don’t have the same herd immunity in the community as they would in the US. I am curious if you have any information to this?

  7. Thanks, Matt, for your perspective and questions. I will keep my eyes open for this type of information.
    US infant immunization programs routinely offer 4 doses of Pneumo-C-13 whereas the Canadian schedules offer 3 or 4 doses depending on province and risk categories.
    I don’t think we are actually able to compare ‘levels of herd immunity’ between countries, or even compare the variability between regions of countries. Analysis of data show that we are noting substantial global decreases (similar to those noted in the US) in both IPD and CAP caused by strains contained in PCV-13 in Canada, and one can infer that increased herd immunity plays a major role. The NACI document goes into the evidence in great detail, with lots of graphs!
    The bottom line is that detection of illness caused by PCV-13 strains are clearly significantly decreased over the past ten years in all populations. The most common implicated strains in IPD and CAP are now non- vaccine serotypes, followed by serotypes contained in pneu-23, and least frequently the strains contained in PCV-13. This is the information that has informed NACI recommendations, which are not substantially different from the current ACIP recommendations.
    I would question the potential industry bias in the presentation? The PCV-13 vaccine is still being promoted to healthy seniors through various channels, which are not always public health evidence based.

  8. Great article. Very helpful, especially the table.

  9. I may have missed it in the article but is the Prevnar 13 covered by public health for adult that are high risk and would benefit most from it? In my experience this is a barrier to administering it. Many of those that need it most are not willing/able to pay for it and so in practice I’m only able to offer them the Pneumovax 23.

  10. Hello Shawn,
    You are correct in that PCV-13 is a private pay vaccine for adults in BC and costs approx $125 in pharmacies and travel clinics. The only adults that are eligible for publicly funded PCV-13 vaccine are those with HIV and recipients of Hematopoetic Stem Cell transplants. It is a barrier, as many people who might benefit from it due to underlying medical illness or health inequity may not be covered by extended health benefits.
    I anticipate that in the next year or two, however, new conjugate vaccine products will be approved in Canada which will change the landscape, potentially be funded, and ‘Change my Practice’! Stay tuned for the next installment.

  11. My understanding is that PPV 23 is covered for patients older than 65 as well as for patients with risk factors who are younger than 65 and booster dose is also covered if they have risk factors? Is that right?
    I wonder if there is a minimum duration between each dose of PPV-23? For example, a patient who gets his dose at age 62 would be going again for the vaccination at age 65 or what? I notice it is recommended to get the PPV 23 for everyone at age 65 regardless of their vaccination status. I would really appreciate some clarity around this. Also, is a repeat dose/booster going to be covered as well? Thanks

  12. Hello Syeda,

    All good questions!

    The interval should be a minimum of 5 years between doses of PPV-23 for those who are at highest risk of invasive pneumococcal disease. Therefore a person who receives a dose at age 62 because they started an immunosuppressive medication would receive a one time booster of PPV-23 dose at age 67, covered by public health. This is given whether or not they choose to take PCV-13.

    The most complicated scenario would be if they receive a first dose of PPV-23 at age 25 when diagnosed with diabetes. This would be followed by a second covered dose at age 30 and then a final dose at age 65.


    Hopefully this is a little less confusing now,

  13. Thank you very much. It is not confusing anymore!

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