Vaccination against pneumococci / measles

Question

Dear expert team,
according to the acutal STIKO-recommendations (permanent vaccination commission of the German Robert-Koch institute) children and adults with a special risk (e.g. CF) should get a pneumococcal vaccination.
I am a CF patient (52y) with permanent antibiotic therapy with azithromycin.
In the year 2009 I have been vaccinated with Pneumovax 23. Unfortunately I had a very strong vaccination reaction (upper arm strongly swollen and painful). Now I have read, that for some years the new vaccine prevenar 13 is licensed for adults, with better tolerance. It would cover the most important germs of this group. Is there the possibility to change to this vaccine now?

Measles vaccination
It is unfortunately not known to me, if I got the measles vaccination in childhood. From the immunization card originating from GDR times it can not be seen, if it had been given. I did not have measles as a child, either. How important would such a vaccination be, if neceassary at all?

Many thanks,
S.

Answer

Dear S.,
you want to have some information on the pneumococcal vaccine and measles vaccine recommendations. Hereby one should stick to the recommendations of the permanent vaccination commission (STIKO).

- To the pneumococcal vaccination:
For adults with health risks due to an underlying disease (as in your case e.g. CF) the STIKO recommends a vaccination with pneumococcal-polysaccharide vaccine PSV-23. In general, a repeated vaccination is not necessary. Only in patients with the following indications a repeated vaccination after 5 years (in case of children younger than 10 years at least 3 years) can be considered: inherited or acquired immune defects with T- and/or B-cell rest function as well as chronic kidney diseases / nephrotic syndrome.
This means, that if you are not suffering from any of those diseases besides the CF, a repeated vaccination with pneumococci is not necessary. Therefore the question about the usage of the 13-valent pneumococcal vaccine (conjugate vaccine) for repetition becomes superfluous.

-To the measles vaccination:
For this I cite the epidemiological bulletin from the 22.04.2013 that can be found on the internet page of the STIKO
www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/16_13.pdf?__blob=publicationFile [German site]
The STIKO recommends for children at the age of 11-14 months the first vaccination with MMR-vaccine (MMR= measles, mumps, rubella). Until the end of the second year of life (recommended at the age of 15-23 months), the second vaccination should be done. This second vaccination leads to the formation of an immunity in those people, that are not sufficiently protected after the first vaccination. Missed MMR vaccinations should be cauhgt up as soon as possible.
For you the following remarks are of interest:
The STIKO recommends a one time standard vaccination of all young (i.e. born after 1970) adults with unclear vaccionation status, without any vaccination or with only one vaccination against measles in childhood. This vaccination can only be done with an MMR vaccine, as monovalent vaccines against rubella as well as against measles are at the moment not available. You declare your age with 52 years, therefore you do not belong to the group of above defined young adults, therefore there is no routine vaccination recommendation agaist measles. Due to the CF, however, in your case it should be decided individually. The determination of measles specific antibodies could be helpful. After a former vaccination against measles, detectable measles specific IgG antibodies over 200mIU/ml show an immunity and therefore protection against recinfection.
For completion of the information on measles vaccination I can also cite the follwoing remark of the STIKO: even if there is already an immunity against one or two components of the vaccine (maybe due to former vaccinations or a wild-type infection) an MMR vaccination is possible without an increased risk of side effects. A vaccination during pregnancy is contraindicated.

I recommend to make a decision together with your CF physician. My answer can probably make the talk easier.

Yours sincerely,
Yours
Dr. med. Christina Smaczny

06.05.2015