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

  • Gerhard FalkenhorstEmail author
  • Johan Flamaing
Part of the Practical Issues in Geriatrics book series (PIG)


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.


Streptococcus pneumoniae Pneumococcal disease Pneumonia Community-acquired pneumonia Vaccination Pneumococcal conjugate vaccine Pneumococcal polysaccharide vaccine 


  1. 1.
    Feldman C, Anderson R. Bacteraemic pneumococcal pneumonia: current therapeutic options. Drugs. 2011;71(2):131–53.CrossRefGoogle Scholar
  2. 2.
    Pneumococcal vaccines WHO position paper—2012. Wkly Epidemiol Rec. 2012;87(14):129–44.Google Scholar
  3. 3.
    Esposito S, Bonanni P, Maggi S, Tan L, Ansaldi F, Lopalco PL, et al. Recommended immunization schedules for adults: clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid). Hum Vaccin Immunother. 2016;12(7):1777–94.PubMedPubMedCentralGoogle Scholar
  4. 4.
    European Centre for Disease Prevention and Control. Vaccine scheduler: pneumococcal disease: recommended vaccinations. Accessed 7 Mar 2018.
  5. 5.
    Government of Canada. Canadian immunization guide: part 4—active vaccines. Page 16: pneumococcal vaccine. 2016. Accessed 7 Mar 2018.
  6. 6.
    Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged >/=65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63(37):822–5.PubMedPubMedCentralGoogle Scholar
  7. 7.
    UK Department of Health. Interim JCVI statement on adult pneumococcal vaccination in the UK. 2015. Accessed 14 Dec 2018.
  8. 8.
    Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013;1:CD000422.Google Scholar
  9. 9.
    Walters JA, Tang JN, Poole P, Wood-Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;1:CD001390.PubMedGoogle Scholar
  10. 10.
    Falkenhorst G, Remschmidt C, Harder T, Hummers-Pradier E, Wichmann O, Bogdan C. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal disease in the elderly: systematic review and meta-analysis. PLoS One. 2017;12(1):e0169368.CrossRefGoogle Scholar
  11. 11.
    Honkanen PO, Keistinen T, Miettinen L, Herva E, Sankilampi U, Laara E, et al. Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older. Vaccine. 1999;17(20–21):2493–500.CrossRefGoogle Scholar
  12. 12.
    Örtqvist A, Hedlund J, Burman LA, Elbel E, Hofer M, Leinonen M, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish pneumococcal vaccination study group. Lancet. 1998;351(9100):399–403.CrossRefGoogle Scholar
  13. 13.
    Scott JA, Hall AJ, Leinonen M. Validation of immune-complex enzyme immunoassays for diagnosis of pneumococcal pneumonia among adults in Kenya. Clin Diagn Lab Immunol. 2000;7(1):64–7.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Musher DM, Mediwala R, Phan HM, Chen G, Baughn RE. Nonspecificity of assaying for IgG antibody to pneumolysin in circulating immune complexes as a means to diagnose pneumococcal pneumonia. Clin Infect Dis. 2001;32(4):534–8.CrossRefGoogle Scholar
  15. 15.
    Maruyama T, Taguchi O, Niederman MS, Morser J, Kobayashi H, Kobayashi T, et al. Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. BMJ. 2010;340:c1004.CrossRefGoogle Scholar
  16. 16.
    Alfageme I, Vazquez R, Reyes N, Munoz J, Fernandez A, Hernandez M, et al. Clinical efficacy of anti-pneumococcal vaccination in patients with COPD. Thorax. 2006;61(3):189–95.CrossRefGoogle Scholar
  17. 17.
    Remschmidt C, Harder T, Wichmann O, Bogdan C, Falkenhorst G. Effectiveness, immunogenicity and safety of 23-valent pneumococcal polysaccharide vaccine revaccinations in the elderly: a systematic review. BMC Infect Dis. 2016;16(1):711.CrossRefGoogle Scholar
  18. 18.
    Jackson LA, Benson P, Sneller VP, Butler JC, Thompson RS, Chen RT, et al. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA. 1999;281(3):243–8.CrossRefGoogle Scholar
  19. 19.
    Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372(12):1114–25.CrossRefGoogle Scholar
  20. 20.
    van Werkhoven CH, Huijts SM, Bolkenbaas M, Grobbee DE, Bonten MJ. The impact of age on the efficacy of 13-valent pneumococcal conjugate vaccine in elderly. Clin Infect Dis. 2015;61(12):1835–8.CrossRefGoogle Scholar
  21. 21.
    Rozenbaum MH, Pechlivanoglou P, van der Werf TS, Lo-Ten-Foe JR, Postma MJ, Hak E. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32(3):305–16.CrossRefGoogle Scholar
  22. 22.
    Public Health England. Pneumococcal Polysaccharide Vaccine (PPV) coverage report, England, April 2016 to March 2017. Health Protection Report. 2017;11(23). Accessed 28 Sept 2017.
  23. 23.
    Scientific Institute for Public Health. [Health survey 2013. Report 5: Prevention]. 2013. Accessed 28 Sept 2017.
  24. 24.
    European Centre for Disease Prevention and Control. Immunisation schedules by target disease: Pneumococcal disease, All EU Countries. Accessed 14 Dec 2018.
  25. 25.
    Falkenhorst G, Remschmidt C, Harder T, Wichmann O, Glodny S, Hummers-Pradier E, et al. Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(12):1623–57.CrossRefGoogle Scholar
  26. 26.
    Grabenstein JD, Musey LK. Differences in serious clinical outcomes of infection caused by specific pneumococcal serotypes among adults. Vaccine. 2014;32(21):2399–405.CrossRefGoogle Scholar
  27. 27.
    Hammerschmidt S, Wolff S, Hocke A, Rosseau S, Muller E, Rohde M. Illustration of pneumococcal polysaccharide capsule during adherence and invasion of epithelial cells. Infect Immun. 2005;73(8):4653–67.CrossRefGoogle Scholar
  28. 28.
    Sugimoto N, Yamagishi Y, Hirai J, Sakanashi D, Suematsu H, Nishiyama N, et al. Invasive pneumococcal disease caused by mucoid serotype 3 Streptococcus pneumoniae: a case report and literature review. BMC Res Notes. 2017;10(1):21.CrossRefGoogle Scholar
  29. 29.
    Weinberger DM, Harboe ZB, Sanders EA, Ndiritu M, Klugman KP, Ruckinger S, et al. Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis. Clin Infect Dis. 2010;51(6):692–9.CrossRefGoogle Scholar
  30. 30.
    Pletz MW, Ewig S, Rohde G, Schuette H, Rupp J, Welte T, et al. Impact of pneumococcal vaccination in children on serotype distribution in adult community-acquired pneumonia using the serotype-specific multiplex urinary antigen detection assay. Vaccine. 2016;34(20):2342–8.CrossRefGoogle Scholar
  31. 31.
    Kuhlmann A, Treskova M, Graf von der Schulenburg JM. [Pneumococcal disease in adults: health economic evaluation of different vaccine scenarios in Germany]. Full report in German. 2016. Accessed 30 Sept 2017.
  32. 32.
    Betsch C, Böhm R, Chapman GB. Using behavioral insights to increase vaccination policy effectiveness. Policy Insights Behav Brain Sci. 2015;2(1):61–73.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Infectious Disease EpidemiologyRobert Koch InstituteBerlinGermany
  2. 2.Department Geriatric MedicineUZ LeuvenLeuvenBelgium
  3. 3.Department of Chronic Diseases, Metabolism, and AgeingKU LeuvenLeuvenBelgium

Personalised recommendations