Information about pneumococcal disease immunisation funded under the Immunise Australia Program.
Recent changes to pneumococcal vaccine for Aboriginal and Torres Strait Islander children in high risk areas
A fourth dose of Prevenar 13® (a 13-valent pneumococcal conjugate vaccine), for Aboriginal and Torres Strait Islander children living in Queensland, the Northern Territory, Western Australia and South Australia will be listed on the National Immunisation Program from 1 October 2012. This coincides with the end of the supplementary program providing Prevenar 13® to children aged between 12 and 35 months who have completed their primary pneumococcal vaccination course with Prevenar® (a 7-valent pneumococcal conjugate vaccine). The 1 October 2012 start date will ensure the continuity of protection for the eligible cohort.
This program provides for the replacement of Pneumovax 23® (a 23-valent pneumococcal polysaccharide vaccine), given as the fourth dose of the pneumococcal vaccination schedule to at risk Aboriginal and Torres Strait Islander children aged between 18-24 months, with Prevenar 13® scheduled at 12-18 months.
Aboriginal and Torres Strait Islander children continue to experience a high incidence of invasive pneumococcal disease (IPD).
Clinical trials have shown that conjugate vaccines, such as Prevenar 13®, are more effective than polysaccharide vaccines, such as Pneumovax 23®, in children under two years of age.
In August 2011, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended an extension of the current listing of Prevenar 13® to provide a fourth dose for Aboriginal and Torres Strait Islander children aged 12 to 18 months in the Northern Territory, Queensland, South Australia and Western Australia.
Moving this fourth dose forward to the 12 to 18 month cohort aligns the provision of the fourth dose for medically at risk children at 12 months of age.
These changes do not apply to Aboriginal and Torres Strait Islander children living in New South Wales, Victoria, Tasmania or the Australian Capital Territory where the rate of IPD is similar to that of non-Indigenous children.
Recent changes to recommendations for the revaccination of adults with Pneumovax 23®
The TGA and ATAGI, including the Pneumococcal Working Party, have each completed reviews on the previously reported increase in adverse event notifications following revaccination of adults with Pneumovax 23®.
New advice on the safety, efficacy and effectiveness of the vaccine, Pneumovax 23 issued by the TGA in December 2011 states that revaccination can be undertaken in accordance with the approved Product Information (PI) for this vaccine.
TGA advises that a second dose of Pneumovax 23®:
- should not be given routinely to immunocompetent individuals (that is, those with a healthy immune system)
- should be considered for patients at a high risk of serious pneumococcal disease, provided that at least five years has passed since the previous dose of Pneumovax 23®.
For more information, please see the TGA website.
Revised vaccination recommendations by the ATAGI are outlined below:
- A dose of Pneumovax 23® should be given to adults at 65 years of age. Every effort should be made to provide a dose to anyone aged >65 years who has not previously received a dose of Pneumovax 23®.
- For non-Indigenous adults aged >65 years, a second dose of Pneumovax 23® (to be given >5 years after the first dose), is recommended for those who have a condition that predisposes them to an increased risk of invasive pneumococcal disease (for details, see Table A in link below).
- A second dose is no longer recommended for those without a predisposing condition (for details, see Table A in link below).
For more information, please see the ATAGI statement.
Ongoing pneumococcal program
From 1 July 2011, Prevenar 13® (a 13-valent conjugate vaccine) replaced Prevenar® (a 7-valent conjugate vaccine) on the National Immunisation Program in all states and territories except the Northern Territory. From 1 October 2011 the Northern Territory will replace Synflorix® (a 10-valent conjugate vaccine) with Prevenar 13®.
Prevenar 13® provides protection against an additional six serotypes, which can cause Invasive Pneumococcal Disease (IPD), that are not covered by Prevenar®. This includes disease associated with the increasingly predominant serotype 19A.
How will this change affect children who have already started a course of Prevenar® or Synflorix®?
Children who have received one or two doses of Prevenar® or Synflorix® will complete their course using Prevenar 13®.
Who is eligible to receive free pneumococcal conjugate vaccine?Pneumococcal conjugate vaccination (Prevenar 13®) will be provided to children at 2, 4 and 6 months of age. A fourth dose may also be provided to medically at risk children at 12 months of age.
Medically at risk children should also receive a dose of 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23®) between 4 and 5 years of age.
Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae. Some types of the bacterium are commonly found in the upper respiratory tract (nose, throat and windpipe) of healthy people. The bacterium can spread between people through infected droplets in the air and by touching an infected person. The disease can cause:
- meningitis (infection of the membranes that enclose the brain and spinal cord);
- pneumonia (lung infection);
- septicaemia/bacteraemia (blood system infection); and
- middle ear and sinus infections.
Pneumococcal meningitis symptoms may include high fever and headache, which may develop over a few hours or 1 to 2 days. Other symptoms may also include:
- sensitivity to light;
- neck stiffness;
- poor appetite;
- irritability; and
Pneumococcal pneumonia symptoms may be vague and include fever, coughing and difficulty breathing.
Pneumococcal blood system infections can cause symptoms such as fever, chills, irritability, drowsiness and rash.
Pneumococcal middle ear infections cause ear pain and a red and swollen ear drum, difficulty sleeping, fever and irritability.
Most pneumococcal infections are vaccine preventable. Pneumococcal vaccination is recommended as part of routine immunisation for children, Older Australians and Aboriginal and Torres Strait Islander people. It is listed on the National Immunisation Program (NIP) Schedule and funded under the Immunise Australia Program. For further information on routine childhood immunisation, refer to the Understanding Childhood Immunisation booklet.
To receive pneumococcal immunisation, visit your local doctor or immunisation provider. It is important to note that the vaccine is provided at no cost, however a consultation fee may apply.
Immunisation against pneumococcal disease is achieved using single-disease vaccines. For information about immunisation in your area contact your State or Territory Health Department.
Pneumococcal immunisation for Older Australians
The National Pneumococcal Vaccination Program for Older Australians commenced in January 2005 and provides free pneumococcal polysaccharide vaccine (Pneumovax23®) to adults aged 65 years or older. People aged 65 years or over should discuss vaccination with their doctor or health care provider.
Adults aged 65 years or over are at higher risk of contracting pneumococcal disease than the rest of the population, with the majority of deaths from this disease occurring in this age group. Every effort should be made to provide a dose to anyone aged >65 years who has not previously received a dose of Pneumovax 23®).
For non-Indigenous adults aged >65 years who do not have any condition that predisposes them to an increased risk of IPD (ATAGI’s advice), a repeat dose of Pneumovax 23® is no longer recommended.
For adults aged >65 years who have a condition that predisposes them to an increased risk of IPD (see Table A of the ATAGI advice), a second dose (a single revaccination) of 23vPPV is recommended. This dose is to be given >5 years after the first dose. (The recommendation for this population subgroup is unchanged.)
For more information, please see the following link: TGA website – Pneumovax 23® – updated revaccination recommendations
Pneumococcal immunisation for Aboriginal and Torres Strait Islander People
Respiratory diseases are major causes of preventable sickness and death in Aboriginal and Torres Strait Islander communities, with some Aboriginal communities having the highest incidence of invasive pneumococcal disease in the world.
In addition to the standard National Immunisation Program (NIP) Schedule, all Aboriginal and Torres Strait Islander children in Queensland, South Australia and Western Australia will receive a dose of 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23®) between the ages of 18 and 24 months. These children do not require a booster dose of Pneumovax 23® if they receive the supplementary dose of Prevenar 13® between the ages of 12 months and 35 months.
In the Northern Territory, the Territory Government will fund Prevenar 13® at 18 months of age for Aboriginal and Torres Strait Islander children.
Free pneumococcal polysaccharide vaccine (Pneumovax23®) is provided through community controlled Aboriginal Medical Services (AMS), State/Territory immunisation clinics and general practitioners, for Indigenous people who are:
- aged over 50; and
- aged 15 to 49 who are at high risk, according to National Health and Medical Research Council (NHMRC) recommendations.
The review undertaken by the TGA and ATAGI (and its Pneumococcal Working Party) on the increase in adverse event notifications and issued new advice on the safety, efficacy and effectiveness of Pneumovax 23® and its place within the National Immunisation Program (NIP) has confirmed previous recommendations on the revaccination of Aboriginal and Torres Strait Islanders with Pneumovax 23®.
For more information, please see the following link: ATAGI Statement Pneumovax 23® – updated revaccination recommendations
For technical information or information about vaccines, refer to the pneumococcal section of the Australian Immunisation Handbook 10th Edition 2013.
Page last modified: 10 February, 2014