Vaccination Against Pneumococcal Disease in the European Union, with Particular Focus on Germany

Abstract

Infection with Streptococcus pneumoniae may cause different clinical presentations, such as acute otitis media and sinusitis in children, while the most common clinical picture in the elderly is pneumonia. Indeed, S. pneumoniae is the most frequent pathogen found in community-acquired pneumonia (CAP). Vaccines against S. pneumoniae have been available for many years and include the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13). Initially, conjugate vaccines were indicated for children <5 years only, but more recently (around 2010–2011 depending on the country), the indication of PCV13 was extended to adults. Guidelines for adult immunization vary between countries, and according to age groups, with the USA and some EU countries recommending sequential vaccination with PCV13 and PPSV23, while other EU countries and Canada recommend PPSV23 only or no routine vaccination of healthy older adults at all. Available current evidence is in favour of a significant protective effect of PPSV23 against invasive pneumococcal disease and pneumococcal pneumonia in the elderly. However, the duration of protection is limited, with immunity waning over a period of about 5 years. Revaccination is crucial to maintain protection and achieve a meaningful impact at a population level.