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Traveler Summary

Key Points

  • Pneumococcal disease is a bacterial infection acquired via the respiratory route; the disease occurs worldwide in travelers and nontravelers.
  • Risk is highest for infants, young children, the elderly, and those with underlying medical conditions and peaks in winter and early spring.
  • Symptoms include sudden onset of fever, chills, cough, difficulty or rapid breathing, and chest pain.
  • Consequences of infection include brain inflammation, respiratory failure, or blood infection.
  • Prevention includes observing good respiratory hygiene and handwashing practices.
  • Two types of pneumococcal vaccine are available, and many people will need both. Prevnar 13 is routinely given to infants in a 4-dose series and is also given to those 65 years and older or to immunocompromised individuals of all ages as a single-dose. Pneumovax 23 is given as a single-dose to adults 65 years and older and to immunocompromised persons 2 years and older.
  • Side effects of both vaccines are most commonly local reactions, fever, decreased appetite, irritability, and sleeping problems.
  • Duration of vaccine protection from Prevnar 13 is lifelong; no booster is required. Duration of protection from Pneumovax 23 is at least 5 years; 1 or 2 boosters are recommended for certain persons.

Introduction

Pneumococcal disease is caused by bacteria and is a leading cause of serious illness (including pneumonia, brain inflammation, and blood infection) among children and adults. Pneumococcal bacteria also cause middle ear infections and sinusitis.

Risk Areas

Pneumococcal disease occurs worldwide. Disease rates and deaths are highest in developing countries, with the majority of deaths occurring in Africa and Asia. Pneumococcal disease is more prevalent in winter and early spring.

Transmission

Transmission usually occurs through direct contact with respiratory droplets or indirect contact with respiratory secretions of infected persons or of healthy carriers of the bacteria.

Risk Factors

Risk is highest for infants, young children, the elderly (especially in institutional settings), those with underlying medical conditions, and those who are immunocompromised. Travelers are at increased risk due to air pollution at many destinations and close contact with large numbers of other individuals during travel.

Symptoms

Symptoms generally include abrupt onset of fever, chills, productive cough (with or without pus- or blood-tinged sputum), and malaise. Chest pain, difficulty or rapid breathing, and shortness of breath may also occur. Headache, nausea, and vomiting occur less frequently. Fever, shortness of breath, or altered mental status may be the initial symptoms in the elderly.

Pneumococcal meningitis may present with stiff neck, headache, lethargy, or seizures.

Consequences of Infection

Pneumococcal disease can lead to meningitis, respiratory failure, or blood infection.

Need for Medical Assistance

Persons with symptoms of pneumonia should seek medical care.

Prevention

Nonvaccine: Observe good respiratory hygiene (cough and sneeze etiquette) and handwashing practices.

Vaccine: Two types of vaccines are available in the U.S., and many people will need both.

  • Prevnar 13 is routinely given to all children aged 2-59 months, all persons 2 years and older with certain conditions that place them at high risk, and all adults 65 years and older.
  • Pneumovax 23 is routinely given to persons 65 years and older, persons 2 years and older with certain conditions placing them at higher risk, cigarette smokers, and residents of nursing homes or other long-term care facilities.

Revaccination with Pneumovax 23 is recommended for persons aged 2-64 years with chronic kidney problems, absence of a functional spleen, or a compromised immune system.

Antibiotics: Penicillin can also prevent pneumococcal infection.

Persons with underlying medical conditions or those who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Travel recommendations: When indicated, these vaccines should be given regardless of travel; however, a minimum interval of 8 weeks between Prevnar 13 and a subsequent dose of Pneumovax 23 (if indicated) may be used in order to receive the Pneumovax 23 dose prior to travel.

Side Effects: For both types of vaccine, mild local reactions (e.g., pain, swelling, and redness at the injection site) fever, decreased appetite, irritability, and increased or decreased sleeping commonly occur.

Timing:

Prevnar 13 is given as follows:

  • Infants younger than 15 months: 4 doses, usually at ages 2, 4, 6, and 12-15 months (first 3 doses may be given as little as 4 weeks apart, if needed). Different regimens apply if vaccination was started late.
  • Children 18 years and younger with certain medical conditions: 1 or 2 doses
  • Adults 19 years and older who are immunocompromised and all adults older than 65 years: 1 dose

If a dose of Pneumovax 23 was inadvertently given before the Prevnar 13 dose, an interval of at least 1 year (for adults) or at least 8 weeks (for children) between the doses is recommended.

Pneumovax 23 is given as follows:

  • Children who are immunocompromised or have certain medical conditions: 1 dose, usually at age 2 years or older
  • Adults 19 years and older with certain medical conditions, who smoke, or who live in long-term care facilities: 1 dose
  • All adults 65 years and older: 1 dose

If Prevnar 13 was given before the Pneumovax 23 dose, an interval of at least 1 year (for healthy adults) or at least 8 weeks (for immunocompromised adults, children, or healthy travelers 65 years and older) between the doses is recommended.

If a second dose of Pneumovax 23 is needed, it is given 5 years after the first Pneumovax 23 dose.