Vaccinations from the pulmonologist's point of view

Abstract

The best strategy for prevention of acute respiratory tract infections is primary prophylaxis against diseases preventable by vaccination. From the pulmonologist's point of view, vaccinations against pneumococci, influenzaA and B viruses and Bordetella pertussis are of particular clinical relevance. This review article discusses the disease burden of these pathogens and the recommendations for immunization in adults. For immunization against pneumococci a less immunogenic but broad-spectrum 23-valent polysaccharide vaccine (PPV23) and a highly immunogenic 13-valent conjugate vaccine (PCV13) with a more narrow-spectrum are approved. A sequential vaccination with PCV13 followed by PPV23 is a new option in adults. In the US this vaccination strategy is recommended as routine vaccination for all adults over 65. In Germany sequential pneumococcal vaccination is proposed only in special indications such as patients with asplenia. Trivalent and quadrivalent split-virus vaccines are the standard vaccines against seasonal influenza in adults. The Standing Committee on Vaccinations (STIKO) recommends a yearly vaccination as standard over 60 and in indications for special risk groups (e.g. infants with underlying diseases, immunocompromised patients, chronically ill patients and pregnant women). For the primary prophylaxis of pertussis only an acellular vaccine is available. Neither vaccination nor a previous infection provide lifelong immunity; therefore, the STIKO recommends an additional booster vaccine for all adults. Vaccination against pneumococci, influenzaA and B viruses as well as Bordetella pertussis are recommended as standard and in special indications for adults by the STIKO at the Robert Koch Institute. For selection of the various vaccines individual factors such as age, immune status, comorbidities and pregnancy have to be considered.