Is it possible to get vaccinated against influenza and pneumococcus at the same time?

Starting from an early age, you can get vaccinated against pneumonia. There are several varieties of it. Like any other vaccine, it can cause complications, but this happens when a person has contraindications to immunization. You need to understand that pneumonia is a deadly disease, and a vaccine can save lives.

Particularly dangerous is pneumonia caused by pneumococci. The disease spreads quickly as it is transmitted by airborne droplets. Moreover, it is almost impossible to isolate the source of infection. Once in the body, pneumococci most often cause pneumonia, although damage to other organs cannot be ruled out. These bacteria can cause otitis media, meningitis, endocarditis and even sepsis.

Pneumonia often ends in death for the patient. Sometimes even the most modern antibiotics are powerless. Bacteria quickly adapt to new drugs, developing resistance to them, so a vaccine was developed to prevent pneumonia. This is the most reliable way to prevent this terrible disease.

Why and who needs vaccination?

Pneumococci most often provoke purulent-inflammatory processes in the human respiratory and nervous system. They cause meningitis, sinusitis, otitis. Every year, many deaths caused by pneumococcal infection are registered around the world. People of all ages with weakened immune systems are at risk.

The complexity of therapy is due to the fact that pneumococci have a very dense membrane. It is difficult for immune cells to destroy it, which is why children are vaccinated against pneumococcus at an early age. The vaccine “teaches” macrophages to recognize these bacteria and effectively destroy them.

Pneumonia is transmitted by airborne droplets; anyone can get sick simply by being near an infected person. Once in the body, the bacterium is able to remain dormant for a long time. It is activated when the immune system weakens, for example, after suffering stress or hypothermia. Once in the systemic bloodstream, pneumococci spread throughout tissues and organs, affecting the lungs, brain and more.

Signs of the disease:

• Fever.
• Muscle pain.
• Shortness of breath and cough with rusty sputum.

The best prevention of pneumonia is vaccination, which is carried out at an early age. Vaccination is necessary for all children, since their immune system is poorly developed and cannot resist germs, so even a common cold can develop into pneumonia.

It makes no sense to vaccinate all adults against pneumonia, but it is necessary for certain categories of citizens, namely:

• Persons with immunodeficiency: patients with HIV, blood cancer, alcoholics, drug addicts, patients with a removed spleen.
• People over 65 years old.
• Persons with chronic diseases of the respiratory system, anemia, diabetes, kidney and liver diseases.
• All military personnel, employees of nursing homes, kindergartens and schools.
• People with congenital abnormalities of the neural tube and spinal cord.

All people at risk can receive free vaccination at their place of residence. The rest of the adult population is vaccinated at will, for a fee.

Does it protect against pneumonia?

Vaccination helps prevent the development of the disease, which means complex multicomponent therapy can be avoided.

The effectiveness of the pneumococcal vaccine according to WHO:

• Among vaccinated children under one year of age, the incidence of colds is reduced by 82% if they are given a protein conjugate drug.
• Bronchitis develops 2 times less often, pneumonia 3 times less often, otitis and sinusitis 4 times less often when a polysaccharide drug is administered.
• The risk of developing cold complications is reduced by 20%.
• The likelihood of infection with the hemophilic form is reduced by 30%.

Vaccination effectiveness:

Pneumococcus: do we need a vaccine?

Pneumonia is an infection caused by streptococci. Most often, pneumonia occurs in children who go to kindergarten. Western experts have been creating a vaccine for a long time to protect our offspring from this infection. The resulting product was immediately approved by WHO and introduced into national vaccination calendars. However, more and more European doctors began to wonder: is this vaccine really necessary?

Text: Tatyana Lapshina, pharmacist, biochemistry teacher (Moscow)

Main cause of pneumonia

The culprit in the development of the disease is pneumococcus (more precisely, the bacterium Streptococcus Pneumoniae

). Its active life in our body leads not only to the development of pneumonia, but also causes the appearance of bronchitis, sepsis, meningitis, and otitis media.

The bacterium primarily affects children under two years of age (their protective system has not yet formed) and older people (their immunity is weakened due to age).

The infection is transmitted by airborne droplets: when talking, sneezing, coughing. It turns out that one sick person in a room can infect a large number of people. It can be difficult to eliminate pneumococcus with antibiotics - the microorganism is too resistant. This state of affairs prompted the medical world to create a pneumococcal vaccine that can protect us and our children from terrible diseases.

Russia and the pneumococcal vaccine

For a long time, immunization of our children against pneumococcus was carried out only for certain indications: for example, if the child is often sick or goes to camp or kindergarten.

Abroad, the situation was different - in most countries, vaccination was included in national calendars.

The Ministry of Health made a decision in accordance with WHO requirements: in January 2014, the pneumococcal vaccine was included in the vaccination schedule. Starting this year, all children are subject to immunization.

Important: Vaccination, according to recommendations, should be carried out three times: in the first year of life twice (at 7 and 9 months) and in the second - once.

The other side of the coin

In most cases, the vaccine is well tolerated by children. Rarely, but side effects occur - redness at the injection site, swelling or the appearance of irritability and temperature. These symptoms disappear after some time.

Other news causes great concern - Western doctors are skeptical about the effectiveness of such vaccination. Discussions reach the point where the vaccine is considered a dummy, saying that it is useless to do it. A number of experts believe that the need to use the pneumococcal vaccine should be checked again - supposedly previous studies were conducted incorrectly.

The information coming to us from the West raises concerns. The “life” of pneumococcus in the United States is burdened by vaccination - the incidence of pneumonia falls every year. In such a situation, other bacteria are not going to sleep and take up the vacant space in the body of children, causing the development of a more serious disease - empyema (accumulation of pus in body cavities). According to one study, hospitalization of children with this diagnosis in the United States increased by 70% (between 1997 and 2006). Scientists believe that the reason lies precisely in the use of the pneumococcal vaccine.

Thus, the question of whether to vaccinate against pneumococcus remains open.

As it turns out, debate about the effectiveness and safety of the vaccine is just beginning to gain momentum. On the one hand, a significant drop in the incidence of pneumonia is observed abroad, noting the high role of vaccination. On the other hand, scientific minds claim that this fact requires further evidence - new research according to a different scheme. But the worst thing is the activation of other bacteria that “decided” to occupy the vacated niche. More time and new research is required.

Photo thinkstockphotos.com

Contraindications

You cannot vaccinate against pneumococcal infection in the following cases:

• Infectious diseases in the acute phase.
• Exacerbation of chronic diseases.
• Pregnancy.
• Undergoing chemotherapy or radiation therapy.
• Allergy to components included in the vaccine.

The vaccine is not given to people who have not tolerated DPT and DPT vaccination well.

Acute diseases of infectious and non-infectious nature, exacerbation of chronic pathologies are temporary contraindications to the vaccine. The vaccine is given 2-4 weeks after recovery or remission. If the cold or intestinal infection was uncomplicated, then immunization can be carried out after the body temperature returns to normal and the person feels normal.

When children start attending kindergarten, they get sick more often. Is this related to pneumococcus?

When a child starts attending kindergarten, he will inevitably receive new microflora (bacteria, viruses...). The carriage of pneumococcus bacteria plays a huge role in this. It is the carriers of pneumococcus that are the reservoir of infection and contribute to the spread of pneumococcal diseases in the surrounding community. The carriage rate of pneumococcus in preschool institutions can reach 72%! Moreover, when colonized with a new strain of Str. pneumoniae, 15% of children develop a disease within 1 month of starting kindergarten, most often acute otitis media.

Numerous studies and statistical data show that children vaccinated with the 13-valent conjugate vaccine against pneumococcal infection when attending kindergarten get sick much less often than unvaccinated children. In addition, vaccinated children are protected from bacterial carriage.

What type of pneumonia are they vaccinated against?

The vaccine is given only against pneumococcal infection. It is this that leads to the development of pneumonia in 70% of cases.

The remaining 30% of pneumonia is caused by other microflora:

• Staphylococcus;
• Streptococci;
• Afanasyev-Pfeiffer wand;
• Aspergillus;
• Viruses;
• Cytomegaloviruses;
• Candida;
• Klebsiella, etc.

Types of vaccinations and their names

To date, several vaccines have been developed against pneumococcal pneumonia. They have different compositions, they are developed by different companies, but they have the same goal - to protect a person from pneumonia.

• Prevenar 13 (America). This is a safe drug that meets the strict requirements of the European Union. After its administration, antibodies to 13 serotypes of pneumococci are activated in the body. 70% of vaccinated individuals develop stable immunity to sore throat, pneumonia and bacterial otitis. Vaccination is carried out between the ages of 2 months and 5 years.
• Pneumo-23 (France). This vaccine protects against 23 serotypes of pneumococci. It is used to vaccinate people aged 2 years and older. Release form: in a 0.5 ml syringe.
• Synflorix. This is a joint development of Russian and Belgian scientists. The drug belongs to the second generation of vaccines; it does not contain preservatives. The vaccine protects against 10 types of pneumococci. The vaccine contains tetanus and diphtheria toxoids. The person will also develop immunity to Haemophilus influenzae.
• Pneumovax 23. This vaccine was created specifically to protect adults, but it can be given to children over 2 years of age. The composition includes polysaccharides from 23 types of pneumococcus. The vaccine is administered 1 time, intramuscularly. The required amount of antibodies is formed by week 13.
• Prevenar. Pneumococcal polysaccharide conjugate adsorbed vaccine.

Adults are given only 2 vaccines: Pneumovax 23 or Prevenar 13.

Prevenar 13 or Pneumovax 23?

Both of them are made in the USA, have passed all clinical trials and give a good immune response. Which one to choose depends on how old the patient is. The fact is that the numbers in the name really matter - Pneumovax 23 protects against 23 serotypes of pneumococcal infection, and Prevenar only against the most common thirteen. However, Pneumovax 23 has a number of limitations that make it unsuitable for a small child:

• it does not form antibodies in children under 2 years of age
• it requires revaccination every 5 years

For routine immunization of people over 50 years of age, Pneumovax 23, on the contrary, is the preferred option, and the CDC (US Centers for Disease Control and Prevention) also recommends choosing Pneumovax 23 for patients who smoke. This is explained by the fact that smokers are at risk for diseases of the pulmonary system.

Let's summarize:

• If we are talking about a newborn, the most intelligent decision is to follow the National Calendar schedule. It includes both pneumococcal infection and hemophilus influenzae, and by the age of one and a half years the baby is already maximally protected from the most dangerous diseases. For routine immunization against pneumococcal infection, Prevenar 13 is used, which is suitable for infants older than 1 month, including premature ones. It is usually done on the same day as other vaccinations - this is permitted by the instructions for the drug, unless we are talking about BCG (it protects against the most dangerous types of tuberculosis and, as a rule, is done in the maternity hospital). If you plan to simultaneously inject a whole-cell pertussis drug (domestic DTP), the child is prescribed an antipyretic for preventive purposes.
• According to the National Calendar, children are given a dose of Prevenar at 2 months and 4 months, and then at 15 months (1 year 3 months).
• If the baby is not yet 2 years old, but the dates according to the National Calendar were missed for some reason, we also choose Prevenar 13. Regarding the individual schedule, it is best to consult with your pediatrician. For children from 1 to 2 years old, a regimen with two injections is used with an interval of at least 2 months.
• If the child is over 2 years old, different immunization regimens are possible, the optimal one of which can be determined by your pediatrician, taking into account the medical history. According to the recommended classical scheme for preschoolers from 2 to 5 years of age, they are still given Prevenar 13 for the first time. Under normal conditions, children over 5 years of age are, as a rule, no longer vaccinated against pneumococcal infection, since with growing up the main danger for them has passed. However, now many parents would still like to protect their child from pneumococcus, and your pediatrician will help you choose a regimen.
• If we are talking about an adult and especially an elderly person, Pneumovax 23 times every 5 years is most likely the optimal solution. However, even here, consultation with a doctor should be your first step: any vaccination has contraindications, and as a rule, a person’s chronic diseases only increase over the years.

How does the vaccine work?

The vaccine does not contain live pneumococci, therefore, after its administration, a person does not get sick. The basis of the vaccine is polysaccharides of the most common serotypes. These high molecular weight carbohydrates cause the immune system to produce antibodies, so that when faced with an infection, it will be ready to resist it.

Some people believe that by getting the pneumococcal vaccine they are permanently protected from pneumonia. However, this is not true; if the immune system is greatly weakened, bacteria will be able to attack the body.

However, the risk of developing pneumonia in vaccinated people is much lower than in unvaccinated people. Even if infection occurs, the disease will be mild and the person will recover faster.

When does it start to work?

The vaccine begins to act within a month after its administration.

Vaccination against pneumococcal infection

In Russia, vaccination against pneumococcus began in 2008 using the Prevenar 7 vaccine. Currently, the following are registered in the country:

• Prevenar 7 and Prevenar 13 (Pfizer),
• Pneumovax 23 (Merck Sharp & Dohme Corp),
• Synflorix (GlaxoSmithKline).

The national vaccination schedules of most developed countries include the Prevenar vaccine; it is recommended by the World Health Organization. At the medical level, residents of Novosibirsk can get vaccinated against pneumococcus with this particular drug.

The effectiveness is confirmed by research! The Prevenar vaccine has been used in the United States since 2000. Already in the first 5 years, the frequency of severe forms of infection in children under 4 years of age decreased by 40 times. According to American researchers, the reduction in the number of pneumococcal carriers, which was achieved through mass vaccination with Prevenar, led to a twofold decrease in visits to doctors for otitis of any etiology.

Wanting to achieve greater effectiveness of the drug against complicated pneumonia, scientists created a new 13-valent vaccine. It contains additional strains of pneumococcus, which are responsible for the development of complications of pneumonia.

According to the Russian vaccination calendar, vaccination against pneumococcal infection is mandatory for all children under 5 years of age. For adults, vaccination is recommended when indicated. It is indicated for conscripts, older people with chronic lung diseases, and pensioners who live in boarding schools and nursing homes.

In general, vaccination can be recommended for all people over 55 years of age and adults with chronic diseases.

Prevenar vaccination schedule

• When vaccinating children under 2 years of age according to the National Calendar, the vaccine is administered three times (at 2 and 4.5 months and at 15 months).
• When vaccinated after two years of age - a single injection intramuscularly into the shoulder.

Preparing for vaccination

To minimize the risk of complications from the vaccine, proper preparation is necessary.

Basic recommendations:

• 2-3 weeks before the upcoming vaccination, the person is monitored. At this time, his well-being should not be disturbed.
• You should not visit crowded places to minimize the risk of infection.
• If the patient has chronic diseases, they must be stopped until a state of remission.
• If a person suffers from allergies, he needs to take antihistamines 7 days before the upcoming immunization. After the vaccine is administered, the course lasts another 14-28 days.
• On the day of the vaccine, the patient must visit a doctor who will examine him and confirm the absence of any diseases.
• 7 days before immunization, you need to exclude from the menu foods that can provoke an allergic reaction. This will help maintain normal immunity.

Proper preparation makes it possible to get the maximum effect from vaccination.

Vaccination schedule

The vaccine is placed in the deltoid muscle of the shoulder if an adult is being vaccinated, and in the thigh muscle if it is a child.

Vaccination schedule for children

The immunization schedule for children is more complex. The pneumonia vaccine can be given in conjunction with other vaccines, except BCG and Mantoux. Depending on the drug chosen, its dosage and the age of the child at which it is administered will differ. A single dose is 0.5 ml.

Vaccination schedule for children:

1. At 2 months – 1 dose.
2. At 4.5 months - 2 doses.
3. Revaccination – at 15 months.

Recommendations for administering the vaccine, depending on the child’s age:

1. Children older than 2 months but younger than six months are vaccinated in 3 stages. The frequency is 1-1.5 months. Then the vaccine is given at 1.1 years.
2. Children 7, 11 and 12 months old are vaccinated 2 times with an interval of 1-1.5 months.
3. For children over 2 years of age, the vaccine is administered once.

How often should adults be vaccinated, and how long does it last?

Immunization of adults is carried out according to indications. There is no strict schedule for vaccinating adults. Vaccination against pneumonia is given once, without revaccination, since with each subsequent administration of the drug, the effectiveness decreases.

However, for people at risk, repeated doses of the drug are recommended every 5 years.

When is the vaccine given?

Today, vaccination against pneumococcal infections is included in the National Vaccination Calendar and is mostly administered in pediatric clinics at the place of residence. There are several stages. One dose is administered to children up to 2 months, then repeated vaccination at the age of 4.5 months and the third stage - in the interval of 12-15 months. If these deadlines are not met and vaccination begins later, doctors will suggest a different regimen.

For the first vaccination, a drug is chosen that protects against 13 strains. It also provides immunity to bacterial diseases caused by pneumococcus, such as sepsis, meningitis, and acute otitis media. After a year, it is recommended to use a drug with protection against 23 strains. The PCV13 vaccine is also recommended for use in children aged 2 to 4 years who have not previously been vaccinated.

Adults can be given PPSV23 at any time. It is worth considering that WHO recommends that elderly people aged 65 years and older receive both drugs at once - it is clear that not together, the timing and sequence should be recommended by a doctor.

At the time of vaccination, a person must be healthy, so it is recommended to undergo examination in the form of basic urine and blood tests, as well as an examination by a pediatrician/general practitioner. This will eliminate the risk of complications.

The injection is given intramuscularly or under the skin. It is prohibited to administer such drugs intravenously. Infants are given an injection in the inner thigh because of the potential need for a bandage that may occur. For adults, the injection is given mainly in the shoulder. Immunity to the vaccine develops within 15 days.

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Reaction after injection

Some parents refuse to vaccinate their child because they fear the following adverse reactions:

• Exacerbation of chronic diseases.
• Quincke's edema.
• Increased body temperature.

However, adverse reactions develop only if the child has not been further examined before the vaccination. This rarely happens, since doctors take a responsible approach to vaccinating children. The classic scheme includes a preliminary examination, administration of a vaccine and 2-3 days of observation of the patient.

Most often, reactions to the vaccine are minimal. They manifest themselves in itching and redness of the skin at the site of drug administration (observed in 5% of cases), as well as an increase in body temperature (in 2% of cases).

The following manifestations cannot be excluded:

• Drowsiness.
• Decreased appetite.
• Seal at the injection site.
• Insomnia and moodiness.
• Increased excitability.
• Chills.

After a maximum of 2 days, these reactions will be completely stopped by the body; they do not pose any threat to health. To help your child cope with post-vaccination reactions more easily, you can give him an antipyretic drug and organize a nap during the day. If after 2 days the condition does not return to normal, you should consult a doctor.

Before administering the vaccination, the doctor examines the child and talks with the parents. Complications develop if adults conceal that the baby had an infection less than 2 weeks before immunization, although this situation is rather an exception to general practice.

Care after vaccination

Parents should know how to care for their child during the post-vaccination period. Basic recommendations:

• No new dishes are introduced into the child’s diet. This is especially true for allergenic products: honey, nuts, citrus fruits.
• Breastfeeding women should not consume foods that are a source of allergies.
• Compliance with the drinking regime is mandatory. This will normalize metabolic processes and reduce intoxication.
• It is forbidden to stick patches on the injection site or smear it with brilliant green or iodine.
• You need to take your child's temperature three times a day. If necessary, antipyretic drugs are given.