Pneumococcal disease

Pneumococcal disease is a respiratory illness which increases in prevalence during the winter months. It is a bacterial infection caused by streptococcus pneumoniae which is found in the upper respiratory tract of healthy individuals.

Pneumococcal infection is responsible for 50 per cent of community acquired pneumonia and bacteraemia in Ireland. It can also cause a wide variety of other infections including sinusitis, osteomyelitis, bronchitis and otitis media. Invasive pneumococcal disease (IPD) is very serious and a major cause of illness and death. Adults aged ≥65 years of age and children < 2 years of age, have the highest IPD disease burden in comparison to other age groups.

Streptococcus pneumoniae has become resistant to many antibiotics making the prevention of disease through vaccination increasingly important.

 

Vaccination

The Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2003, as amended enable community pharmacists to supply and administer PPV23. Since 2015 many community pharmacies have been providing a private Pneumococcal Vaccination Service in line with national immunisation guidance. PPV 23 vaccine contains purified polysaccharide from 23 of the most common capsular types of streptococcus pneumoniae, which account for up to 90 per cent of all serious pneumococcal infections. It is licensed for active immunisation against pneumococcal disease in children aged from two years, adolescents and adults. A patient can receive PPV23 at any time of the year however it tends to be given during autumn and winter when prevalence is highest and these patients are presenting in pharmacies for other vaccinations such as influenza and COVID-19. The National Immunisation Advisory Committee (NIAC) recommend vaccination for individuals at increased risk of pneumococcal disease, those aged 65 years and older and ‘at-risk’ adults and children over two years of age. Community pharmacists, via CPA 2025, can now provide PPV 23 vaccination to healthy over-65-year-olds who are eligible under the national immunisation programme. Those aged two or over and in an at-risk group are eligible for free PPV23 vaccination from their GP.  

Eligibility for free vaccination in community pharmacy

As outlined in HSE Circular NCO-15-2026 from May 2026, the following patients are eligible for vaccination, using HSE vaccine stock, through community pharmacy:

• Healthy individuals aged 65-and-older:
  • Without Group A or Group B risk factors, as defined by NIAC within ‘Table 16.1: Conditions associated with an increased risk of invasive pneumococcal disease’;
  • Who have not previously received PPV23 after the age of 65 years;
  • Who have not received the PPV23 within the preceding five-year period;
  • Who have not received a pneumococcal conjugate vaccine (PCV) within the preceding eight-weeks; and
  • Who have no clinical contraindications to receipt of vaccination.

Pharmacies are reimbursed by the HSE for administering a public vaccine to healthy patients aged 65 years and older as outlined above who have GMS/GPVC/HAA eligibility.

Healthy patients aged 65 years and older as outlined above who do not have GMS/GPVC/HAA eligibility can be vaccinated using a public vaccine, and the pharmacist may charge a private fee for administering the vaccine.

 

Establishing vaccination history

Revaccination with PPV23 can produce severe local reactions, especially if given within five years of the previous injection.

Those who received one dose of PPV23 at age ≥65 years should not receive a further dose regardless of immune status.

Pharmacists should establish the vaccination history of patients and take all possible steps to confirm that the patient has not received PPV23 within the preceding five-year period or has not previously received PPV23 after the age of 65 years.

Vaccination history can be checked using the Vaccination History Search (VHS) facility in HSE PharmaVax, which displays all public PPV23 vaccines administered in general practice since September 2022 and all PPV23 vaccines administered through community pharmacy since September 2022.

The following records will NOT show in the VHS:

• PPV23 administered before September 2022;
• PPV23 provided privately by GPs;
• PPV23 given in other settings, for example, acute hospitals or private facilities; and
• PCV administered.

Therefore, vaccination history may need to be confirmed with the individual’s GP or treating specialist.

 

Recording vaccines

PPV23 administration records for both public and private vaccinations must be recorded in HSE PharmaVax, from which data is ingested into the National Immunisation Information System (NIIS). It is important that all records are entered at time of vaccination, or in any event within seven days as required by legislation, so that clinical records are kept up to date, and are available for other providers so that duplicate vaccination does not occur.

HSE PharmaVax will now display two Payor Types for PPV23 records, as follows:

• HSE Public: This should be selected if the individual is over-65 and clinically eligible as outlined above AND has GMS/GPVC/HAA eligibility, and the pharmacy is claiming reimbursement through PCRS. It is the responsibility of the pharmacist to confirm that that patient has current eligibility, this can be established by using the Secure Scheme Checker; and
• Private: This should be selected in both of the following cases:
  • The individual is over-65 and clinically eligible as outlined above, is vaccinated using HSE vaccine stock but does not have GMS/GPVC/HAA eligibility and is being charged a private fee for administration of the PPV23; and
  • All other private PPV23 administered in line with national guidance, where the individual is being charged for both the vaccine and the administration. Private stock should be used in this instance.

 

Fee arrangements

As agreed as part of CPA 25 a fee of €28.50 will be paid to community pharmacy contractors for administration of a PPV23 by a pharmacist to an eligible individual in the relevant age cohort under GMS/GPVC/HAA eligibility, provided that the vaccine is not administered by the community pharmacy on the same day as the administration of a publicly reimbursed influenza vaccine.

A fee of €42.75 will apply for the administration of Influenza and PPV23 vaccinations on the same day by the community pharmacy contractor where the administration of both vaccines is publicly reimbursed.

Where the individual is healthy and aged 65 years or older and does not have GMS/GPVC/HAA eligibility, it will be a matter for the community pharmacy contractor to determine a private fee for administering the vaccine.

 

Training

Pharmacists must ensure the required training is up-to-date and valid as per PSI guidance available on the PSI website’s Vaccinations Training section.

Pharmacists are also required to have up to date knowledge on the pneumococcal vaccine they are administering and can meet the training requirements in this regard by:

• Completing the ‘Administration of Pneumococcal Polysaccharide Vaccine’ module on the IIOP portal; and/or
• Through review of or having up-to-date knowledge in the relevant National Immunisation guidelines for Ireland, ‘Chapter 16 Pneumococcal Infection’, the Summary of Product Characteristics (SPC) for the vaccine PNEUMOVAX 23 solution for injection in pre-filled syringe and HSE guidance (where applicable).

Pharmacists should also ensure that they are familiar with the most recent national guidance on immunisation and the management of anaphylaxis, as contained within the Immunisation Guidelines for Ireland from NIAC and Immunisation Bulletins from the National Immunisation Office.

Comprehensive information for pharmacists on the training required to supply and administer vaccines and/or emergency medicines is available at psi.ie > Education and Training > Vaccinations Training.

 

Vaccines and ordering

PPV23 is available to order online from the National Cold Chain Service (NCCS) at ordervaccines.ie. The HSE stock of PPV23 supplied through the NCCS is only to be administered to healthy individuals aged 65-and-older. It will be delivered in a similar manner to influenza and COVID-19 vaccines with fortnight deliveries. Pharmacists are reminded to review the delivery calendar and confirm cut-off dates prior to confirming appointments for a pneumococcal service. For any queries relating to vaccine orders or deliveries the NCCS customer services team is available at vaccines@udd.ie or phone 01 463 7770.

Private stock of PPV23 for administration to patients outside of this group is available to order directly from wholesalers in a routine manner.

 

Supports and queries

The HSE National Immunisation Office (NIO) are currently updating the Adult Pneumococcal Information leaflet. This leaflet answers many questions patients may have in relation to the vaccine, the disease and those who should have the vaccine. The leaflet will be available to order shortly from healthpromotion.ie.

Pharmacists may also find ‘Figure 16.5: Pneumococcal polysaccharide vaccination algorithm’, adapted from NIO found on page 11 of Chapter 16 (Pneumococcal Infection) of the National Immunisation Guidelines, a useful resource when assessing patients suitability for vaccination. For any clinical queries contact the NIO at immunisation@hse.ie.

There is no national HSE Medical Eligibility and Consent Form for PPV23. It is the responsibility of the pharmacist to conduct a medical eligibility assessment and ensure that informed consent is obtained prior to vaccination in line with the HSE National Consent Policy. The IPU have a Consent and Medical Eligibility form to support the administration of PPV23 available on the IPU Pneumococcal Hub, which is suitable for the provision of the vaccine to patients healthy over 65-year-olds as part of the National Immunisation Programme and also as part of a private service. The hub also contains an SOP template for the Provision of a Pneumococcal Vaccination Service as well as a range of other supports to help with delivery in practice.

The HSE Relationship Management Team are available to support with general queries and issues. They can be contacted on 081 800 8811 or by email on pharmacyvaccines@vision.com.

If you have any queries or require support the IPU Professional Services Team can be contacted at pharmacists@ipu.ie.