Available Vaccines
Pneumococcal Disease
In this chapter:
Introduction
The pneumococcal disease is caused by Streptococcus pneumoniae, a gram-positive, encapsulated diplococcus with over 100 identified serotypes, based on the capsular polysaccharide. The polysaccharide capsule is its most important virulence factor and 15 of the serotypes are responsible for the majority of the invasive pneumococcal diseases (IPD). Type-specific antibody to this capsular polysaccharide is protective.
Based on data from the Institute for Medical Research (IMR) collected from 2019-2022, the predominant serotypes identified in Malaysian adults were 3, 6A, 19A,19F, 23A and 23F.
The pneumococci commonly colonize the nasopharynx, often without causing symptoms. The nasopharynx acts as the main reservoir for transmission. Asymptomatic carriage is estimated to be 20-60% in children and 5-10% in adults. Pneumococcal infection can affect multiple organ systems leading to pneumonia, bacteremia, meningitis, otitis media and sinusitis.
The risk of pneumococcal disease decreases after early childhood but increases again in older age. This suggests acquisition of natural immunity in early life and its waning in older adults due to immunosenescence and increased vulnerability from comorbid conditions.
Table 20.1 Vaccines Registered in Malaysia
1. Prevnar 13 Prescribing Information. 3 November 2021; 2. Kobayashi M, et al. MMRW. 2022;71(4):109-117.; 3. Capvaxive Prescribing Information. July 2025. 4. Pneumovax 23 Prescribing Information. April 2021.
*PCV21 is not yet available in Malaysia.
Table 20.2 High-risk Groups in Malaysia
Evidence of Safety & Effectiveness
Protection from anti-capsular antibodies is generally serotype-specific; however, cross-protection against serotypes within a serogroup can occur – e.g. between 6A and 6C. The use of PPSV requires a booster dose every 5 years if indicated (maximum 3 lifetime doses: more than this is associated with hyporesponsiveness). Currently, using PCV only needs a single dose and additional booster doses are not routinely recommended.
Pneumococcal conjugate vaccine (PCV) reduces nasopharyngeal colonisation, thereby decreasing the spread of infection. In countries with childhood vaccination coverage exceeding 50%, the rate of invasive pneumococcal disease (IPD) in adults decreased by 28% and rates of IPD due to strains covered by PCV13 decreased by 40%. However, this has been accompanied by a 20% increase in IPD due to non-PCV13 strains in the elderly.
References
- Bonten, M. J., Huijts, S. M., Bolkenbaas, M., et al. (2015). Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults. New England Journal of Medicine, 372(12), 1114-1125. https://doi.org/10.1056/nejmoa1408544
- Vadlamudi, N. K., Chen, A., & Marra, F. (2019). Impact of the 13-Valent Pneumococcal Conjugate Vaccine Among Adults: A Systematic Review and Meta-analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 69(1), 34–49. https://doi.org/10.1093/cid/ciy872
- Bonnave, C., Mertens, D., Peetermans, W., Cobbaert, K., Ghesquiere, B., Deschodt, M., & Flamaing, J. (2019). Adult vaccination for pneumococcal disease: a comparison of the national guidelines in Europe. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology, 38(4), 785–791. https://doi.org/10.1007/s10096-019-03485-3
- Greenberg, G.M., Koshy, P.A., Hanson, M.J.S. (Nov 2022) Adult Vaccination, Am Fam Physician, 106(5):534-542. https://www.aafp.org/pubs/afp/issues/2022/1100/adult-vaccination.pdf
- Shah AA. Simplifying pneumococcal immunizations for adults. Am Fam Physician. 2022;105(6):580-581. https://www.aafp.org/pubs/afp/issues/2022/0600/p580.html
- Fletcher, M. A., Vojicic, J., Daigle, D., et al. (2024). National recommendations for adult pneumococcal vaccination in countries of the WHO regions of Americas, Africa, Eastern Mediterranean, South-East Asia, and Western Pacific. Vaccine, 42(26), 126390. https://doi.org/10.1016/j.vaccine.2024.126390
- Kobayashi, M., Leidner, A. J., Gierke, R., et al. (2025). Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices – United States, 2024. Morbidity and mortality weekly report, 74(1), 1–8. https://doi.org/10.15585/mmwr.mm7401a1
- Kobayashi, M., Pilishvili, T., Farrar, J. L., et al. (2023). Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 72(3), 1–39. https://doi.org/10.15585/mmwr.rr7203a1
- Kobayashi, M., Farrar, J. L., Gierke, R., et al. (2022). Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices – United States, 2022. Morbidity and mortality weekly report, 71(4), 109–117. https://doi.org/10.15585/mmwr.mm7104a1