폐렴구균 감염병(폐렴연쇄구균 감염병 /폐렴알균 감염병) 백신 예방접종, Immunization for streptococcus pneumoniae infections/peumococcal infections

폐렴구균 감염병(폐렴연쇄구균 감염병 /폐렴알균 감염병) 백신 예방접종, Immunization for streptococcus pneumoniae infections/peumococcal infections

폐렴연쇄구균을 폐렴연쇄상구균, 폐렴사슬알균, 폐렴알 구균, 폐렴 연쇄균, Streptococcus pneumoniae 라고 한다.

• 폐렴구균에는 무려 90여 혈청형으로 나누어진다.
• 90여종의 폐렴연쇄구균의 세균종들 중 특히 4, 6B, 9V, 14, 18C, 19F, 23F 세균혈청형의 감염으로 인해 중이염, 축농증(부비동염), 폐렴, 관절염, 패혈증, 또는 뇌막염(수막염) 등의 감염병이 생길 수 있다.
• 폐렴연쇄구균 감염으로 인한 감염병을 예방할 수 있는 PCV13(프레브날 백신/Prevnar vaccine) 예방접종 백신과 23 세균혈청형의 폐렴연쇄구균 감염으로 인해 생기는 폐렴연쇄구균성 감염병을 예방할 수 있는 PPSV23(23 valent pneumococcal polysaccaride vaccin) 예방접종 백신이 있다.
• 현재 미국에서는 폐렴연쇄구균 감염병을 예방하기 위해 기본 예방접종을 받을 때 주로 쓰는 프레브날 예방접종 백신은 2세 이하 영유아들에게 예방접종 하는데 주로 쓰고 있다.
• PPSV23 예방접종 백신은 24~59개월 유아들에게 예방접종할 때 주로 쓰고 있다.

사진 3-10. 가슴 X-선 사진.

폐렴 구균은 폐렴, 관절염, 패혈증 뇌막염 등 여러 종류의 감염병의 원인이 될 수 있다.

Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

• 후천성 면역 결핍증이 있거나 선천성 면역 결핍증이 있거나
• 비장이 없거나 비장의 기능이 정상적이 아니거나
• 신증후군,
• 만성 신장 부전증,
• 기관 이식을 받은 아이,
• 만성 폐렴,
• 심장 우혈증,
• 뇌막액이 뇌막외로 새는 병
• 항암제 치료,
• 방사능 치료,
• 장기간 스테로이드 치료를 받거나
• 에이즈나 악성 종양을 앓거나
• 당뇨병 등 만성 대사성 질병을 앓거나
• 3세 이하 모든 건강한 영유아들
• 특히 탁아소나 데이케어에 가는 영유아들
• 그 외

• 생후 2, 4, 6, 12~15 개월에 1회 접종해 총 4차 접종받는다.
• 생후 6주에 1차 접종을 받을 수 있다.
• 적어도 4∼8주 간격을 두고 접종받을 수 있다.
• 4차 접종은 3차 접종을 받은 후 적어도 2개월 후에 접종을 받는다.

• 임신 중
• 디프테리아 톡소이드 백신이나 프레브날 예방접종 백신에 알레르기가 있을 때
• 고열이 나면서 감염병을 앓을 때는 그 감염병이 다 나은 후에 접종받는다.
• 열이 나지 않고 감기를 경미하게 앓을 때는 접종받을 수 있으나 의사와 상의한 후 접종 받는 것을 최종 결정한다.

• 소아청소년 건강검진을 받고 열이 나는지 알아보기 위해 체온을 재고 발열성 감염병이 없고 예방접종 백신에 알레르기가 없고
• 예방접종에 금기가 없으면 프레브날(PVC13) 백신 0.5cc 근육주사로 접종받는다.
• 디프테리아, 파상풍, 백일해, 히브, 소아마비, 홍역, 풍진, 볼거리, 수두, 또는 B형 간염을 예방해 줄 수 있는 예방접종 백신과 프레브날 예방접종 백신을 동시 접종받을 수 있다.

• 프레브날 백신 주사를 맞은 부위에 부종, 압통, 발적이 생길 수 있다.
• 열, 기면증, 식욕감퇴, 과민, 구토, 설사, 발진 등 경미한 부작용도 생길 수 있다.
• 드물게 알레르기 반응이 생길 수 있다.

• 프레브날(PCV13) 폐렴연쇄구균 예방접종 백신으로 폐렴연쇄구균의 23 세균 혈청형 감염에 의한 감염병을 예방접종을 받으면 면역 효과는 거의 100%이지만 폐렴연쇄구균의 나머지 83여 세균 혈정형균의 감염으로 생길 수 있는 폐렴연쇄구균 감염병을 예방할 수 있는 면역체는 생기지 않는다.
• 그런 이유로 PCV13 폐렴연쇄구균 예방접종 백신으로 권장 한 대로 완전 배열 접종을 받은 후에도 나머지 83여 세균 혈청형의 폐렴연쇄구균 감염으로 폐렴 등 폐렴연쇄구균 감염병에 걸릴 수 있다.

표 3-5. 생후 7개월까지 폐렴연쇄구균 감염병 백신 예방접종을 한 번도 받지 않은 영유아들은 다음 예방 접종 스케줄과 같이 예방접종을 받는다.

• • + 1차 접종과 2차 접종은 적어도 4주 간격을 두고 받는다.
  • 3차 접종을 생후 12개월 이후에 해 줄 때는 적어도 2개월 간격을 두고 접종한다.
  • ++ 적어도 2개월 간격을 두고 접종한다.
  • www.prevnar.com 참조.
• 2010년 3월 12일부터  미국에서는 7가 PCV 백신 (PCV 7 )으로 접종받는 대신 PCV13가 백신으로 접종 받도록 권장 한다.

■ 폐렴 구균 백신 예방접종 

Immunization for streptococcus pneumoniae infections/peumococcal infections,폐렴구균 감염병(폐렴연쇄구균 감염병 /폐렴알균 감염병) 백신 예방접종 

• Streptococcus pneumoniae is called pneumococcal, pneumococcal, pneumococcal, pneumococcal, and Streptococcus pneumoniae.
• Pneumococcus is divided into about 90 serum types.
• Otitis media, sinusitis (sinusitis), pneumonia, arthritis, sepsis, or meningitis due to infection with the bacterial serotype 4, 6B, 9V, 14, 18C, 19F, 23F, especially among 90 types of pneumococcal bacterial species Infectious diseases such as back may occur.
• PCV13 (Prevnar vaccine) vaccine, which can prevent infectious diseases caused by pneumococcal infection, and PPSV23 (23 valent pneumococcal), which can prevent pneumococcal infectious diseases caused by bacterial serotype pneumococcal infection. PPSV23(23 valent pneumococcal polysaccharide vaccin is available.
• Currently, in the United States, the prevenal vaccination vaccine, which is mainly used to receive basic vaccinations to prevent streptococcal pneumonia, is mainly used to immunize infants and young children under 2 years of age.
• The PPSV23 vaccine is mainly used when vaccinating infants from 24 to 59 months old.

Photo 3-10. Chest X-ray picture.

• Pneumococcal can cause many types of infectious diseases such as pneumonia, arthritis, septic meningitis, and so on. Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP

Children in the following high-risk groups should be vaccinated against pneumococcal vaccine.

• Have an acquired immunodeficiency or have a congenital immunodeficiency, or
• There is no spleen or the function of the spleen is not normal
• Nephrotic Syndrome,
• Chronic kidney failure,
• A child who has had an organ transplant,
• Chronic pneumonia,
• Cardiac failure,
• A disease in which meningeal fluid leaks outside the meninges
• Chemotherapy,
• Radiation therapy,
• Receiving long-term steroid therapy
• With AIDS or malignant tumors,
• Suffering from chronic metabolic diseases such as diabetes
• All healthy infants under the age of 3, especially for infants who go to daycare centers or daycare
• etc

Inoculation age of pneumococcal infectious disease (pneumococcal infectious disease) vaccination

• After 2, 4, 6, 12 to 15 months of age, you will receive a total of 4 vaccinations once inoculated. They can get the first dose at 6 weeks of age. Vaccinations can be given at least 4-8 weeks apart.
• The 4th vaccination is given at least 2 months after receiving the 3rd vaccination.

Contraindications to vaccination against pneumococcal infectious disease

• During pregnancy

• Allergic to Diphtheria Toxoid Vaccine or Prevenal Vaccine
• If you suffer from infectious disease while having a high fever, you will be vaccinated after the infectious disease has healed.
• If they do not have a fever and have a mild cold, they can get the vaccination, but after consulting your doctor, they will decide to receive the vaccination.

Inoculation method of  vaccination

• After taking a health checkup for children and adolescents, they measure their body temperature to see if they have a fever.
• If there are no contraindications to vaccination, 0.5cc intramuscular injection of Prevenal (PVC13) vaccine is given.
• They can get together the pneumococcal vaccine and the preventable vaccine to prevent diphtheria, tetanus, whooping cough, hives, polio, measles, rubella, mumps, chickenpox, or hepatitis B.

Side effects of vaccination against streptococcal pneumonia (pneumococcal infection) vaccine

• Swelling, tenderness, and redness may occur in the area where the prevenal vaccine was injected. Some minor side effects such as fever, narcolepsy, loss of appetite, irritability, vomiting, diarrhea, and rash can also occur.
• Rarely, an allergic reaction can occur.

Preventive effect of vaccination against streptococcal pneumococcal disease (pneumococcal infection)

• Prevent (PCV13) is a vaccine against streptococcal pneumococcal infections caused by 23 bacterial serotypes of pneumococcus.
• It does not develop an immune system that can prevent streptococcal pneumococcal infections.
• For that reason, even after receiving a complete sequence vaccination as recommended for the PCV13 pneumococcal vaccine, the remaining 83 bacterial serotypes may suffer from pneumococcal infections such as pneumonia.

Table 3-5. Infants and toddlers who have never been vaccinated against streptococcal pneumonia by 7 months of age will be vaccinated according to the following vaccination schedule.

• 12~23 months after birth 2++1 +
• The 1st and 2nd vaccinations are given at least 4 weeks apart.
• If the 3rd vaccination is given after 12 months of age, the vaccination should be at least 2 months apart.
• ++ Inoculate at least 2 months apart.
• See www.prevnar.com.
• From March 12, 2010, in the United States, it is recommended to receive PCV13 vaccine instead of the 7-valent PCV vaccine (PCV 7).

■ Pneumococcal vaccine

Types of vaccine for pneumococcal infection

• There are 3 types of pneumococcal infectious disease vaccines, such as PCV7, PCV13, and PPSV23. But these days, I mainly use PCV13 (Prevnar13) and PV23 (Pneumovax).
• The PCV13 vaccine can be used when vaccinating children and adolescents aged 6 to 17 years old, and adults can be used when vaccinating children up to 50 years of age or older. PCV13 has 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 3, 5, 6A, 7F, 19A pneumococcal serotypes. The PPSV23 vaccine is recommended for children over 2 years of age or older with high health risks.

Prevention of pneumococcal infection vaccine

• Refer to Table 4 of pediatric infectious disease vaccination recommended by the American
• Academy of Pediatrics and Adolescents in 2015.
• Pneumococcus has more than 90 bacterial serotypes, of which 13 is the PCV13 (Prevnar13 vaccine) vaccine that can prevent infectious diseases caused by serum-type pneumococcal infection.
• Pneumococcal infectious diseases such as otitis media, sinusitis, pneumonia, arthritis, sepsis, and meningitis caused by pneumococcal infection can be prevented if inoculated with the pneumococcal vaccine as recommended for the PCV13 vaccine.
• 23:PPSV23 (23 Valent pneumococcal polysaccharide), which can prevent infectious diseases caused by bacterial serotype pneumococcal infection, should be inoculated from 2 years of age to 59 months of age.
• From March 12, 2010, in the United States, instead of receiving the vaccine with the 7th PCV vaccine (PCV7), it is recommended to receive the PCV13 vaccine at 2, 4, 6, 12-15 months of age and catch up at 59 months of age.
• Premature infants weighing 1500g or less begin to receive vaccinations at 6-8 weeks of age. If a child aged 15 to 71 months has not been vaccinated with PCV13 and belongs to the health risk group, it is recommended to receive the vaccine with PCV13.
• No immunization with PCV13, no anatomical or functional spleen, or human immunodeficiency
• Virus-infected, cochlear implantation, cerebrospinal fluid ductal or other immune impairment
• Therefore, it is recommended that people at high risk of contracting invasive pneumococcal infectious diseases are vaccinated with PCV13 (at intervals of 8 weeks) and then additionally vaccinated with PPSV23 at 2 years of age.
• And at the age of 5, It is recommended to get a second booster dose. Before the age of 65, do not receive more than two vaccinations with PVV23.
• It is recommended that children between the ages of 6 and 18 who have previously been vaccinated with PPSV23 and who have not been vaccinated with PPSV13, get one dose with PPSV13.
• If the 2nd PPSV23 vaccination is necessary, at least 5 years after receiving the 1st PPSV23 vaccination, the 2nd PPSV23 vaccination will be given.
• Do not get 2 doses of PPSV23 vaccination before the age of 65. A 2-year-old child or older child who is at risk of contracting invasive pneumococcal infectious disease as a preceding disease should be vaccinated with the PPSV23 vaccine as soon as they are diagnosed with such a preceding disease.
• Children who are going to receive solid organ transplantation treatment, or children 2 years of age or older who want to undergo splenectomy, should be vaccinated with the PPSV23 vaccine before receiving transplantation treatment or at least 2 weeks before splenectomy.

The following high-risk groups must be vaccinated against pneumococcal vaccine:

• Have an acquired immunodeficiency or congenital immunodeficiency,
• or Born without a spleen due to congenital or acquired spleen by surgical removal of the spleen Have hyposplenism function, or
• Congenital or acquired immune system deficiency,
• or Sickle cell disease or any other type of hemoglobin disease,
• or Nephrotic syndrome, chronic kidney failure,
• organ transplant,
• chronic pneumonia,
• heart congestion,
• erebrospinal fluid leaking cerebrospinal fluid,
• Malignant tumors, leukemia, lymphoma, Hodgkins disease, or other types of malignant tumors are treated with anticancer drugs,
• radiation therapy,
• or corticosteroid therapy for a long period of time immediately before the start of chemotherapy,
• or With AIDS or malignant tumors,
• People who have received chronic diseases such as diabetes,
• chronic heart disease,
• chronic lung disease,
• or cochlear transplantation
• All healthy infants under the age of 3 Especially for children going to day care centers or day care Since there are more than 90 pneumococcal serotypes,
• all pneumococcal serotypes cannot be vaccinated against pneumococcal infection, and even after all vaccinations, pneumococcal infectious diseases of all pneumococcal serotypes cannot be completely prevented.
• [Parents should also be at least the half-doctors-Child and Family Nursing Encyclopedia]-Volume 2 Prevention of diseases and safety accidents in children and adolescents-Refer to Children without Spleens.

Table 2-17. Infants and toddlers who have never been vaccinated against pneumococcal infectious disease by 7 months of age or school-age children receive catch-up vaccinations as shown in the following table.

• +: The first and second doses are given at least 4 weeks apart.

• When receiving the 3rd vaccination after 12 months of age, receive the vaccination at least 2 months apart.

• ++: Get vaccinated at least 2 months apart. • For more information, please visit www.prevnar.com.

• From March 12, 2010, in the United States, it is recommended to receive the PCV13 vaccine and/or the PPSV23 vaccine instead of the PCV7 vaccine.

Contraindications to vaccination against pneumococcal vaccine

• during pregnancy

• Allergic to diphtheria toxoid or prevenal vaccine

• If you suffer from an infectious disease while having a high fever, receive the vaccination after the infectious disease is cleared.

• If you don’t have a fever and have a mild cold, you can get the PCV13 vaccine.

• If you have a child and adolescent health checkup, have a fever, have a body temperature, do not have a febrile infection, are not allergic to the vaccine, and there are no other contraindications, get a PCV13 (prevenal) vaccine.

How to get vaccinated against pneumococcal vaccine

• Inoculate 0.5cc by intramuscular injection.

• You can get both a vaccine that can prevent diphtheria, tetanus, whooping cough, hives, polio, measles, rubella, mumps, chickenpox, or hepatitis B, as well as a prevenal vaccine.

Side effects of pneumococcal vaccine

• Swelling, tenderness, and redness may occur in the area where the vaccine was given.

• Minor side effects such as fever, narcolepsy, loss of appetite, irritability, vomiting, diarrhea, and rash may occur. • Rarely, an allergic reaction may occur.

Effects of pneumococcal vaccination

• Pneumococcal vaccination with the PCV13 vaccine showed almost 100% of the serotype immunity effect of the pneumococcal vaccine,

but there is no immune effect to prevent the pneumococcal infection caused by the remaining pneumococcal serotype infection.

Effects of pneumococcal vaccination Pneumococcal vaccination with PCV13 vaccine showed almost 100% of the serotype immunity effect of the pneumococcal vaccine,

but there is no immune effect to prevent pneumococcal infection caused by the remaining pneumococcal serotype infection.

Is there a way to prevent the spread of pneumococcal to other people, which prevents the development of pneumococcal infectious diseases in children who go to children’s homes or other places where children live in groups outside the home?

The carrying rate of nasopharyngeal mucosal pneumococcal (inoculated serotype) was decreased in children vaccinated with PCV7 vaccine,

but the carrying rate of nasopharyngeal pharyngeal pneumococcus did not decrease after inoculation with PCV23.

However, after inoculation with PCV13, the carrying rate of nasopharyngeal mucosal pneumococcal (inoculated serotype) decreased.

Studies so far have shown that antibiotic prophylaxis cannot reduce the incidence of invasive pneumococcal infections.

The relationship to other types of vaccination vaccines when vaccinated against pneumococcal infectious diseases With the exception of Menactra (MenACWY-D) meningitis, all other bacterial infectious diseases vaccinations and concurrent pneumococcal vaccinations can be vaccinated.

출처 및 참조문헌

• www.drleepediatrics.com 제1권 소아청소년 응급 의료
• www.drleepediatrics.com 제2권 소아청소년 예방
• www.drleepediatrics.com 제3권 소아청소년 성장 발육 육아
• www.drleepediatrics.com 제4권 모유,모유수유, 이유
• www.drleepediatrics.com 제5권 인공영양, 우유, 이유식, 비타민, 미네랄, 단백질, 탄수화물, 지방
• www.drleepediatrics.com 제6권 신생아 성장 발육 육아 질병

• www.drleepediatrics.com제7권 소아청소년 감염병
• www.drleepediatrics.com제8권 소아청소년 호흡기 질환
• www.drleepediatrics.com제9권 소아청소년 소화기 질환
• www.drleepediatrics.com제10권. 소아청소년 신장 비뇨 생식기 질환
• www.drleepediatrics.com제11권. 소아청소년 심장 혈관계 질환
•  www.drleepediatrics.com제12권. 소아청소년 신경 정신 질환, 행동 수면 문제
• www.drleepediatrics.com제13권. 소아청소년 혈액, 림프, 종양 질환
• www.drleepediatrics.com제14권. 소아청소년 내분비, 유전, 염색체, 대사, 희귀병
• www.drleepediatrics.com제15권. 소아청소년 알레르기, 자가 면역질환
• www.drleepediatrics.com제16권. 소아청소년 정형외과 질환
• www.drleepediatrics.com제17권. 소아청소년 피부 질환
• www.drleepediatrics.com제18권. 소아청소년 이비인후(귀 코 인두 후두) 질환
• www.drleepediatrics.com제19권. 소아청소년  안과 (눈)질환
• www.drleepediatrics.com 제 20권 소아청소년 이 (치아)질환
• www.drleepediatrics.com 제21권 소아청소년 가정 학교 간호
• Red book 29th-31st edition 2021
• Nelson Text Book of Pediatrics 19^th- 21st Edition
• The Johns Hopkins Hospital, The Harriet Lane Handbook, 22nd edition

• Childhood Emergencies in the Office, Hospital and Community, American Academy of Pediatrics
• Emergency Medical Service for Children, By Ross Lab. May 1989. p.10
• Emergency care, Harvey Grant and Robert Murray
• Emergency Care Transportation of Sick and Injured American Academy of Orthopedic Surgeons
• Emergency Pediatrics A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
• Immediate care of the acutely ill and injured, Hugh E. Stephenson, Jr
• The Critically Ill Child, Diagnosis and Management, Edited by Clement A. Smith
• Emergency Medical Services for Children: The Role of the Primary Care Provider, America Academy of Pediatrics
• Quick Reference To Pediatric Emergencies , Delmer J. Pascoe, M.D., Moses Grossman, M.D. with 26 contributors
• Manual of Emergency Care
• 응급환자관리 정담미디어
• 소아가정간호백과–부모도 반의사가 되어야 한다, 이상원
• Neonatal Resuscitation American heart Association
• Neonatology Jeffrey J.Pomerance, C. Joan Richardson
• Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.
• Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.
• Preparation for Birth. Beverly Savage and Dianna Smith
• Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A. Gerhon, Catherine Wilfert
• The Harriet Lane Handbook 19th Edition
• 소아과학 대한교과서
• 제1권 소아청소년 응급의료 참조문헌과 출처
• 제2권 소아청소년 질병․안전사고 예방 참조문헌과 출처
• Other

Copyright ⓒ 2015 John Sangwon Lee, MD., FAAP

“부모도 반의사가 되어야 한다”-내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances. “Parental education is the best medicine.”