PPV (Pneumococcal Polysaccharide Vaccine)

Key vaccine facts

This vaccine gives protection against 23 different types of pneumococcus bacteria that all cause pneumococcal disease. These 23 types cause about 9 out of every 10 infections caused by pneumococcus bacteria.

PPV can safely be given at the same time as the seasonal flu vaccine and the shingles vaccine.

The vaccine does not contain any live bacteria, and cannot cause pneumococcal disease.

The brand name for the PPV used in the UK is Pneumovax 23. See the Patient Information Leaflet .

Who should have the vaccine?

In the UK, PPV is given to adults aged 65 and over. Pneumococcal vaccines (PPV and PCV) are also recommended for people of all ages with some health conditions who are at greater risk of complications from pneumococcal disease. This includes people with:

immunosuppression, a missing spleen, sickle cell anaemia or coeliac disease
chronic liver disease, kidney disease or heart disease
chronic lung conditions
chronic brain (neurological) conditions including learning disability
diabetes
cochlear implants
cerebrospinal fluid leaks
complement disorders (the complement system is an important part of the immune system)

People who are exposed to metal fumes (for example, welders) are at higher risk of pneumococcal disease and may also be offered PPV.

People over 65 are given a single pneumococcal vaccination. Those with a long-term health condition are offered just a single pneumococcal vaccination, or vaccination every five years, depending on their underlying health problem.

PPV is not recommended for children under 2 because it does not work well in this age group. There is a similar vaccine for babies and children (the PCV - Pneumococcal Conjugate Vaccine).

What protection does the vaccine give?

PPV prevents some types of serious pneumococcal disease, but it does not prevent all forms of the disease. It is less effective against pneumonia, otitis media (ear infection) and sinusitis. See 'Does the vaccine work?' below.

Ingredients

The PPV used in the UK is a polysaccharide vaccine. Small amounts of polysaccharides (sugars) from the surface of 23 different pneumococcus bacteria are used to produce an immune response. The vaccine does not contain any live organisms. Apart from the active ingredients (the antigens), it contains very small amounts of these ingredients:

sodium chloride (salt)
A very small amount of phenol, used as a preservative.

Other brands of PPV used in other countries may contain different ingredients. If you are not in the UK, ask for the Patient Information leaflet for the vaccine you are offered.

Side effects

Very common (affecting more than 1 in 10 people at each dose):

soreness, pain, redness, warmth, swelling or hardening at the injection site
raised temperature (fever)

Rare (affecting up to 1 in 1000 people at each dose):

swelling in the injected limb

Anaphylaxis

As with any vaccine, medicine or food, there is a very small chance of a severe allergic reaction (anaphylaxis). Anaphylaxis is different from less severe allergic reactions because it causes life-threatening breathing and/or circulation problems. It is always extremely serious but can be treated with adrenaline. Health care workers who give vaccines know how to do this. In the UK between 1997 and 2003 there were a total of 130 reports of anaphylaxis following ALL immunisations. Around 117 million doses of vaccines were given in the UK during this period. This means that the overall rate of anaphylaxis is around 1 in 900,000.

More information on side effects

Reactions listed under ‘possible side effects’ or ‘adverse events’ on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.

If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme . You can also contact the MHRA to ask for data on Yellow Card reports for individual vaccines . See more information on the Yellow Card scheme and monitoring of vaccine safety.

More information about the vaccine

Can the PPV be given at the same time as the shingles vaccine?

The Summary of Product Characteristics for Zostavax, the shingles vaccine used in the UK, states that the vaccine should not be given at the same time as the Pneumococcal Polysaccharide Vaccine. This is because a clinical trial by the manufacturer had suggested this might make Zostavax less effective. However, the Department of Health advice is that the two vaccines can be given at the same time. This is based on expert advice from the Joint Committee on Vaccination and Immunisation , and on research that showed no evidence that people receiving both vaccines together had any increased risk of developing shingles. Read the abstract of the 2011 study by Tseng et al .

Does the vaccine work?

A 2013 Cochrane review looked at 25 studies of PPV vaccine effectiveness in over 125,000 people. It found strong evidence that the PPV was effective against invasive pneumococcal disease (meningitis and septicaemia) in adults. It also said that ‘Evidence from the included studies indicates vaccination might not afford as much protection in adults with chronic illness as it does for healthy adults. The available evidence does not demonstrate that pneumococcal polysaccharide vaccines prevent pneumonia (of all causes) or mortality in adults.’

Studies have shown that protection offered by the PPV wanes after about 3 years, and that PPV is less effective in over 75s than in 65-75 year olds (see Andrews et al, 2012 and Suzuki et al, 2017 ). The vaccine is also not very effective in people with some types of immunosuppression, and in people with some other long-term health conditions. The vaccine is recommended in the UK because it prevents invasive pneumococcal disease (including meningitis) and meets the criteria for cost-effectiveness. Adults are also protected against pneumococcal disease through herd immunity. Vaccination of babies with the infant pneumococcal vaccine, the PCV, has reduced the amount of disease in the whole population, because infants and children are no longer carrying so many pneumococcal bacteria and spreading them around.

In 2011, the UK's Health Protection Agency (now Health Security Agency) published research on the impact of the children's pneumococcal vaccine programme . It showed a big reduction in serious disease caused by the 13 types of pneumococcal bacteria protected against by the PCV. Another study by Public Health England (now UK Health Security Agency) published in 2015 confirmed that 8 years of PCV use in England and Wales had reduced the overall incidence of invasive pneumococcal disease by more than 50%. However, the 2015 research noted that other strains of pneumococcal bacteria were starting to become more common, and could partly replace the strains that are disappearing, especially in non-vaccinated older individuals. Public Health England has continued to monitor this trend. It has found that strains not covered by the PCV have increased, and are causing more cases of pneumococcal disease (over 4000 cases in 2015-16, compared with about 2000 cases in 2010-11). Recent reports can be found here .

At the moment the disease caused by these strains is generally less severe and less likely to be fatal. There is still a very substantial reduction in disease in young children but non-vaccine strains have replaced the reductions in disease in older age groups to some extent. Public Health England is continuing to monitor the situation. Future strategies might include development of vaccines for a wider set of organisms, especially for those causing replacement disease in the elderly. With the increase in strains of pneumococcal bacteria not covered by the PCV, the PPV now has the potential to prevent more disease than previously and further work is needed to assess current effectiveness against contemporary circulating strains.

Videos about the vaccine

In the short film below, Dr Andrew Prendergast talks about pneumococcal disease and why it is important to vaccinate against the disease.

What is Pneumococcal Disease and why do we need a vaccine?

https://www.youtube.com/embed/Vaj3rmDNQEU?wmode=opaque&controls=&rel=0

Pneumococcal meningitis - Sam's story

Sam Willis had pneumococcal meningitis when he was 9 months old, before the vaccine was available. In this film, made when Sam was 11 years old, his father talks about the lasting effects of the disease and the impact on the whole family.