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Burden of Disease

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Risk Factors

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Secondary Infections

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Prevention of Pneumococcal Disease

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Prevenar 13® Clinical Experience

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Effectiveness of Prevenar 13® 


Indian Clinical Trials

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Recommendations for Use

Recommendations for Use

ACIP 2019NCCN 2020RSSDI 2020IMA GuidelinesIAOH Guidelines for Working AdultsClinical Practice Guidelines 2019 (ICS/NCCP)The Geriatric Society of India, 2015Indian Society of Nephrology

PCV13 in Pulmonology

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PCV13 in Nephrology

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PCV13 in Oncology

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PCV13 in Rheumatology


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PCV13 in HIV Infection

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Pneumococcal Disease and Influenza 

Hospitalisations and deaths associated with influenza are largely caused by associated complications including pneumonia and acute exacerbation of underlying conditions like cardiopulmonary diseases and acute renal failure. However, pneumonia is the most common and serious complication associated with influenza. Following influenza infection, pneumococcal pneumonia is particularly common.1 Although regulation of secondary pneumonia infection following the incidence of influenza remains unclear, it has been observed that prior influenza infection affects pneumococcal adherence and invasion. This highlights the need for preventive measures against both influenza and secondary pneumococcal infections. Evidence indicate that rather than limiting secondary pneumococcal infection, limiting influenza infection could be more effective in preventing pneumococcal pneumonia in these patients.2

The association between the bacterium S. pneumoniae and the influenza virus has been proposed as a polymicrobial system, where the pathogenicity and transmission of one pathogen is affected by interactions with the other pathogen.3 A study evaluated the role of influenza in the epidemiology of pneumonia using a mechanistic transmission model and reported that influenza infection leads to a 100-fold increase in the risk of pneumonia.4 Similar findings were reported by another study, which revealed that there exists a strong but short-lived interaction between the 2 pathogens and that influenza infection leads to around a 100-fold increase in the susceptibility to pneumococcal pneumonia.3

In the Indian setting, data on the contribution of influenza leading to CAP in adult population are scarce. A study of adults from North India hospitalised with CAP assessed the microbial aetiology of CAP in these patients. This study involved 225 adults with the median age being 59 years. S. pneumoniae (30.5%) and influenza viruses (15.4%) were among the most common aetiological agents for these adults with CAP. In those cases where the aetiology of pneumonia was polymicrobial, influenza was found to be a co-pathogen in 33% of such patients.5

Since pneumonia and exacerbations of the underlying chronic illness are the major causes of influenza-related hospitalisations, use of both pneumococcal and influenza vaccines is strongly recommended in the adult population with comorbidities.6 A Phase 3, randomised, parallel-group, multicentre trial conducted across 34 sites in the United States evaluated the safety, immunogenicity and tolerability of PCV13 co-administered with TIV in pneumococcal vaccine-naïve adults. This study enrolled adults aged 50 to 59 years. It revealed that the co-administration of PCV13 with TIV in this group of adults was well tolerated and immunogenic. However, co-administration of the 2 vaccines was associated with a relatively lower antibody response for PCV13 as compared to the administration of PCV13 alone, the clinical significance of which was unknown. This study concluded that owing to the positive immunogenic attributes of PCV13, co-administration of the 2 vaccines should be considered, particularly in the clinical setting.7 Another randomised controlled trial assessed the effects of co-administration of PCV13 with TIV in PPSV23-naïve adults aged ≥65 years. This study reported that the co-administration of both the vaccines demonstrated acceptable safety and immunogenicity as compared to either of the vaccines given alone.8

Another randomised study evaluated the response of PCV13 co-administered with QIV in adults aged ≥50 years and previously immunised with PPSV23. The immune response for co-administered vaccines was non-inferior as compared to either of the vaccines given alone, albeit lower for co-administered PCV13. This study concluded that the concomitant use of PCV13 and QIV can be considered in this adult population, when they are pre-immunised with PPSV23.9 A Phase 4 study reported that the concomitant use of PCV13 and QIV yielded a similar immune response as compared to QIV alone and was well tolerated. Although the immune response was non-inferior to that of PCV13 alone, lower PCV13 responses were observed in the co-administration group of adults.10 All these studies confirmed the safety and immunogenicity of co-administration of PCV13 and either of the influenza vaccines, TIV or QIV, in the older adult population.

Several studies have described the impact of PCVs in preventing influenza-associated morbidity and mortality in children. An analysis of adults aged ≥65 years estimated the efficacy of PCV13 in the prevention of hospitalisations due to CAP-associated influenza. While in the PCV group, 23 cases of CAP-associated with influenza were observed, the number was 35 in the placebo group, with a 34.4% vaccine efficacy. However, since this study was a secondary analysis for which the original trial was not powered, the PCV efficacy was not statistically significant.11,12

Vaccinations against both influenza and pneumococcal infections are recommended for preventing CAP in adults. Several national and global guidelines recommend the concomitant use of pneumococcal and influenza vaccines in the adult population.13 The CDC recommends the co-administration of a pneumococcal vaccine (either PCV13 or PPSV23) with an influenza vaccine during the same visit at different sites.14 CDC recommend the co-administration of both the vaccines, but administering at different sites.13

Concomitant administration of PCV13 and the influenza vaccine (TIV or QIV) can significantly lower the risk of pneumonia, even in the elderly (aged ≥50 years) population.7,9

Watch the video on COPD Vicious Cycle Adult Prevenar.


Watch the video on Protect Your Cardiac Patients From Pneumococcal Pneumonia.




ACIP, Advisory Committee on Immunization Practices; CAP, community-acquired pneumonia; CDC, Centers for Disease Control and Prevention; CFR, case fatality rate; IPD, invasive pneumococcal disease; PCV, pneumococcal vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine; TIV, trivalent inactivated influenza vaccine; QIV, quadrivalent inactivated influenza vaccine. ​​​​​​



Song JY, Noh JY, Lee JS, et al. Effectiveness of influenza and pneumococcal polysaccharide vaccines against influenza-related outcomes including pneumonia and acute exacerbation of cardiopulmonary diseases: analysis by dominant viral subtype and vaccine matching. PLoS One. 2018;13(12):e0207918.
Seon SH, Rhee DK. Effective prevention of secondary pneumococcal infection following influenza virus infection. Future Microbiol. 2018;13:953-955.
Shrestha S, Foxman B, Weinberger DM, Steiner C, Viboud C, Rohani P. Identifying the interaction between influenza and pneumococcal pneumonia using incidence data. Sci Transl Med. 2013;5(191):191ra84.
Shrestha S, Foxman B, Berus J, et al. The role of influenza in the epidemiology of pneumonia. Sci Rep. 2015;5:15314.
Para RA, Fomda BA, Jan RA, Shah S, Koul PA. Microbial etiology in hospitalized North Indian adults with community-acquired pneumonia. Lung India. 2018;35(2):108-115.
Song JY, Lee JS, Wie SH, et al. Prospective cohort study on the effectiveness of influenza and pneumococcal vaccines in preventing pneumonia development and hospitalization. Clin Vaccine Immunol. 2015;22(2):229-234.
Frenck RW Jr, Gurtman A, Rubino J, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19(8):1296-1303.
Schwarz TF, Flamaing J, Rümke HC, et al. A randomized, double-blind trial to evaluate immunogenicity and safety of 13-valent pneumococcal conjugate vaccine given concomitantly with trivalent influenza vaccine in adults aged ≥65 years. Vaccine. 2011;29(32):5195-5202.
Thompson AR, Klein NP, Downey HJ, et al. Coadministration of 13-valent pneumococcal conjugate and quadrivalent inactivated influenza vaccines in adults previously immunized with polysaccharide pneumococcal vaccine 23: a randomized clinical trial. Hum Vaccin Immunother. 2019;15(2):444-451.
Baxter R, Downey JH, Patterson SD, et al. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine coadministered with a quadrivalent influenza vaccine in adults 50 years and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Open Forum Infect Dis. 2015;2(Suppl 1):LB-7.
Huijts SM, Coenjaerts FEJ, Bolkenbaas M, et al. The impact of 13-valent pneumococcal conjugate vaccination on virus-associated community-acquired pneumonia in elderly: exploratory analysis of the CAPiTA trial. Clin Microbiol Infect. 2018;24(7):764-770.
Klugman KP, Madhi SA, Ginsburg AS, Rodgers GL. The role of bacterial vaccines in the prevention of influenza mortality. Lancet Glob Health. 2018;6(12):e1268-e1269.
Administering pneumococcal vaccines. Centers for Disease Control and Prevention. Accessed May 17, 2022.
Dhar R. Review of guidelines for the use of vaccines to prevent community-acquired pneumonia in Indian adults. JAPI. Supplement. 2016;64:45-51. Accessed May 17, 2022.


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PP-PRV-IND-0661 July 2023

Burden of Disease


Help protect your adult patients against pneumococcal pneumonia with single-dose administration

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Efficacy proven by the CAPiTA study

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Recommendations for Use

The ACIP recommends routine use of PCV13 among adults

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