P2.2 Pneumococcal immunisation

Pneumococcal immunisation is recommended for all patients with COPD.  Pneumococcal immunisation with conjugated vaccines covering 13 virulent serotypes (13vPCV) is highly effective in preventing community-acquired pneumococcal pneumonia in older adults (Bonten 2015). In contrast, the pneumococcal polysaccharide vaccine covering 23 virulent serotypes (23vPPV) is less effective in elderly or immunosuppressed patients (Simberkoff 1986). People with COPD vaccinated with injectable polyvalent pneumococcal vaccines are less likely to experience an episode of community-acquired pneumonia (OR 0.62 (95% CI 0.43-0.89)) with a NNTB of 21 to prevent one episode of pneumonia (95% CI 15-74) and vaccination also reduces the likelihood of an exacerbation of COPD (OR 0.6 (95% CI 0.39-0.93)), NNT of 8 to prevent one exacerbation (95% CI 5-58) (Walters 2017) [evidence level I].

For those with newly diagnosed COPD who have never received pneumococcal immunisation: a first dose of 13vPCV (conjugated vaccine) is recommended at diagnosis followed by up to two additional doses of 23vPPV regardless of age. The number of lifetime doses of 23vPPV is now limited to 2 doses for all people who are recommended to receive 23vPPV. The doses of 23vPPV received in the past are also counted when deciding how many more are required. If a person has already received at least two doses based on previous recommendations, no further doses of 23vPPV are to be given.

In the current national immunization program (NIP) patients under the age of 65 years with COPD and chronic emphysema are not included in the risk conditions for National Immunisation Program (NIP) funded pneumococcal vaccination. Consequently, they are not eligible for reimbursement. The NIP provides funding for 13vPCV followed by 23vPPV vaccine for Aboriginal and Torres Strait Islander adults 50 years and over.

Please see the The Australian Immunisation Handbook for further details.

The additive effect of pneumococcal immunisation to annual influenza immunisation has been studied in a randomised, controlled trial over two years in Japanese patients with chronic lung disease (Furumoto 2008). They found a significant additive effect of receiving both vaccines on exacerbations in patients with COPD (influenza vaccine alone = 26% versus both vaccines =10.3%, p = 0.037), supporting current recommendations for dual immunisation.