In the general measures, related to host defences, the following are recommended3:

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  smoking cessation;

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  control of chronic illnesses (diabetes mellitus, COPD, congestive heart failure, chronic renal failure, chronic liver disease, HIV/AIDS infection, etc.);

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  judicious use of immunosuppressive therapies (including corticosteroids);

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  alcohol counselling (including acute intoxication and chronic alcoholism);

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  advice about dealing with cases of drug addiction;

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  adequate nutritional status;

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  gamma globulin IV immunotherapy in selected patients (IgG deficiency, multiple myeloma, chronic lymphocytic leukaemia, transplant patients).

This endorses the Directorate-General of Health recommendation for vaccination against seasonal flu for the current season.4 Health professionals and other professionals involved in front-line health care are a priority group for vaccination, because of the increased risk of contracting the illness and transmitting it to their families and their patients. Setting an example and the counselling about vaccination given by health professionals represent one of the principle success factors in keeping to vaccination targets.

In Portugal two pneumococcal vaccines are available for adults aged 18 and above, a pneumococcal polysaccharide vaccine 23-valente [(Pneumo 23®) VPP23] with 23 serotypes (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F) and a pneumococcal conjugate vaccine 13-valente [(Prevenar 13®) VPC13] with13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F). Both vaccines are intramuscular and VPP23 can also be administered subcutaneously.5,6

For adults, vaccines are indicated for the prevention of invasive pneumococcal diseases by the serotypes included in the vaccine. The bacteraemia secondary to pneumonia is the main manifestation of invasive pneumococcal disease in adults, representing about 75% of cases of invasive disease in the adult population7 and more than 80% in those ≥65.8

At the present time, we are waiting for the results of studies about the efficacy of VPC13 in the prevention of pneumonia in adults.

Epidemiological surveillance programmes on invasive pneumococcal disease and its serotypes at a national level are crucial for the evaluation of the effectiveness of anti-pneumococcal vaccines and recommendations for their utilization. According to the latest data available at a national level, relating to the period 2006–2008, from a total of 1100 isolates of Streptococcus pneumoniae in adults with an invasive pneumococcal disease, 68% of the serotypes identified were included in VPC13 and 84% in VPP23.9

Table 1 presents recommendations for antipneumococcal vaccinations according to the risk of invasive pneumococcal disease.7,8,10–13

In adults who are indicated for antipneumococcal vaccination, the following dosing schedule is suggested10:

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  adults who have not previously been vaccinated should first receive VPC13 followed by a dose of VPP23 at least 8 weeks later;

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  adults who have already been vaccinated with VPP23 should only receive VPC13 at least one year after the last vaccination of VPP23;

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  for adults with indication for revaccination with VPP23, the second dose must only be given at least 5 years after the first dose of VPP23 and at least 8 weeks after administration of VPC13.

Revaccination with VPC13 is not recommended and in the case of VPP23, revaccination should only be done once (Fig. 1).

Figure 1.

Schedule for antipneumococcal vaccination in non-vaccinated individuals or previously vaccinated with VPP23.

(0.08MB).

Pneumococcal vaccines should be administered at the most propitious time for the immune system to respond; Table 2 presents an optimization calendar of vaccinations for certain clinical conditions (adapted13).

The influenza and pneumococcal vaccines can be given at the same time, preferably in different arms.

The recommendations presented in this document should be subject to clinical judgement in relation to the individual cases.

This document will be subject to periodic revisions in order to include the scientific evidence of future studies and knowledge about other measures and vaccines like, for example, the whooping cough which is available and recommended in some European countries.14,15