Vaccines – pneumococcal and influenza

Dr Louise Johnson educates us on winter vaccines pneumococcal and influenza – for people living with diabetes.

What is pneumococcal disease?

Pneumococcal disease is caused by the bacterium Streptococcus pneumonia (S. pneumonia). This can cause infection in the respiratory tract i.e. lung, sinus or ears.

In vulnerable people, such as children, the elderly, and people living with diabetes, these bacteria can invade the bloodstream and cause meningitis and septicaemia. This may lead to deafness, mental disability and even death. People at extreme ages (younger than two years or older than 65 years) are particularly susceptible to the complications because of their underdeveloped immune system or aging immune system.

Pneumococcal bacteria are spread from person to person through close contact with respiratory secretions (sputum or saliva).

Why immunise?

It is estimated that immunisation approximately prevents 2,5 million deaths a year due to infections. It is also cost-effective to the health system and has saved more lives than the development of antibiotics.1

Antibiotic-resistance is a reality, and resistance to commonly used antibiotics is becoming a serious threat to medical treatment of infections.

In the age of antibiotic-resistant bugs, the prevention of disease through vaccines has become essential. It not only helps prevent infections in vaccinated people, but also prevents a “herd immunity” by helping to prevent transmission of the bug to close contacts of the sick patient.

Types of vaccines:

There are two different types of pneumococcal vaccines available:

  1. PPV23 (Pneumovax 23)

Pneumococcal polysaccharide vaccine is made from polysaccharide (sugar like) capsule of 23 different strains of S. pneumonia.

This capsule is the main target of the body’s immune response during pneumococcal infection. The body produces antibodies when exposed to the capsule (acts like an antigen).

The next time the immune system is exposed to the same antigen, the immune system is prepared and can rapidly produce killing-antibodies. This is due to the body having a “memory” of the antigen via specially produced immune memory B-cells.

Children younger than two years of age have an immature immune system and cannot produce memory cells to the capsule. Therefore, they should not get this vaccine.

  1. PCV13 (Prevenar 13)

Pneumococcal conjugate vaccine is like PPSV23. Though, a protein that induces memory cells, even in young children, joins the capsular polysaccharide.

Who should be vaccinated with which vaccines?

Pneumovax 23:

Persons older than 65 years.

People older than two years with chronic heart and lung disorders, diabetes, chronic liver disease, COPD, alcoholism, spleen dysfunction, asplenia (spleen removed), cancer, organ transplantation, HIV infection and smokers.

Prevenar 13:

Children aged: six weeks, four months, and 12 months.

Children with underlying medical conditions should get an extra dose at six months. This is part of the South African Immunisation Programme.

How to vaccinate?

South African guidelines to CAP (community acquired pneumonia)2

Vaccination is the key pillar of antibiotic stewardship.

  • All patients older than 50 years who are vaccine naïve should receive a single-dose of PCV13.
  • Every adult older than 50 years who have received PPV23 should receive a single-dose of PCV13 one year later.
  • All adults older than 65 years of age who are vaccine naïve should receive a single-dose of PCV13, followed a year later by PPV23.
  • Every adult older than 65 years of age who have received PPV23, should receive a single-dose of PCV13 at least one year later.
  • Younger adults (>18 year) who are vaccine naïve with severe underlying comorbid or immunocompromising conditions, including HIV infection, should receive a single-dose of PCV13, followed at least two months later by PPV23.
  • Younger adults (> 18 years) who have previously received PPV23 and have severe underlying comorbid or immunocompromising conditions, including HIV infection should receive a single-dose of PCV13 one year later.
  • All women who are pregnant in the period of influenza vaccine availability, should be offered vaccination with influenza vaccination of that year.
  • Adults older than 65 years of age should receive the annual vaccination for influenza.
  • Individuals with chronic diseases (diabetes, lung disease, heart disease, HIV infected individuals and morbidly obese (BMI>40kg/m2) are at high risk and should be vaccinated.
  • All healthcare workers should be offered annual influenza vaccination.

Who should not be vaccinated?

Pneumovax 23 should not be given to children younger than two years. Hypersensitivity to the products in the vaccine.

What are the side effects of the pneumococcal vaccine?

Side effects are very uncommon. Local side effects to the injected area: redness, soreness, or rash. Also fatigue, headache, chills and diffuse achiness.

What is influenza?

Influenza (also known as flu) kills between 6 000 and 11 000 South Africans per year. These deaths are 50% in the elderly and 30% in HIV infected people.

The highest rate of hospitalisation is in people older than 65 years of age, HIV-infected people, and children less than five years of age.

Patients with chronic diseases, such as diabetes, heart and lung disease and tuberculosis are also at higher risk of contracting influenza.3

Flu is a virus and is spread from person to person. It causes many different symptoms from headache, fatigue, muscle pain, shivers, vomiting and diarrhoea.

It spreads mainly by droplets when people cough, sneeze, or talk. You can also get flu by touching a surface or object that has flu virus on it and then touching your mouth, eyes or nose.

What is in the flu vaccine?

The flu vaccine contains three different types of inactivated flu viruses. This mean the virus is dead and can’t make you sick. The viruses in the flu injection are named for the year they were found and the place they were found. This year’s vaccine (2019) was updated with two new viruses. The current vaccine contains:

  1. A/California/7/2009(H1N1) pdm09 like virus
  2. A/HongKong/4801/2014(H3N2) like virus
  3. B/Brisbane/60/2008 like virus

Who should get the flu vaccine?

  • Pregnant and post-partum women (anytime during pregnancy).
  • People who are infected with HIV.
  • Healthcare workers.
  • People with chronic diseases (diabetes, lung, heart, kidney, liver, etc.)
  • People older than 65 years of age.
  • Residents of old age homes, chronic care and rehabilitation centres.
  • Children older than six months.
  • Adults and children in close contact with high-risk individuals.
  • Anyone wishing to reduce the risk of getting flu or spreading flu to others.

Who should not get the vaccine?

Anyone who had a severe allergic reaction to the vaccine, such as drop in blood pressure and difficulty in breathing.

Can I get the flu vaccine when I am sick?

Yes. You are safe to get the vaccine with mild cold or flu-like symptoms even if you have a fever. Though, if you are very ill (need to be admitted to a hospital) you should rather wait.

How effective is the flu vaccine?

The flu vaccine prevents only influenza and no other viruses. It is 60% effective in healthy individuals. The elderly and children younger than two years may not respond as well due to weaker immune system.4

Therefore, when looking at the bigger picture of population and personal health: be wise and vaccinate.


  1. Plotkin SA, Mortimer E.A, Vaccines 2ndedition, Philadelphia:Wb Saunders, 1994
  2. J Thorac Dis 2017; 9 (6):1469-1502
  3. ( (
Dr Louise Johnson


Dr Louise Loot is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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