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| General information - pneumococcal conjugate |
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| What
vaccine products are available to vaccinate children? |
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| In 2000, the first pneumococcal
conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained
seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of Streptococcus pneumoniae and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten
years later in February 2010, a new 13-valent product was licensed --
PCV13 (Prevnar 13, Pfizer) -- which added 6 new serotypes (1, 3, 5, 6A,
7F, and 19A). Together, these 13 serotypes account for the majority of
invasive pneumococcal disease (IPD) in the U.S., including serotype 19A,
which is the most common IPD-causing serotype in young children. In
February 2010 ACIP recommended that healthcare providers transition from
use of PCV7 to use of PCV13 for routine vaccination of children. |
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| What vaccination schedule should we
follow for PCV13? |
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| Generally, you should follow the same
4-dose schedule you followed for PCV7, administering doses at ages 2, 4,
6, and 12-15 months. Following are additional recommendations concerning
PCV 13: |
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| 1. |
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For children who have
begun a series of PCV7, replace all remaining doses with PCV13. If
you are unsure how to assess and complete the pneumococcal conjugate
vaccine immunization schedule for children who may have fallen
behind, consult the pneumococcal vaccine catch-up schedule that can
be found at www.immunize.org/shop/views/childsched_pg4.pdf. |
| 2. |
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For children who have
completed a 4-dose or other age-appropriate series of PCV7 |
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a. |
Give one
additional dose of PCV13 to all healthy children who have not yet
reached their fifth birthday. |
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b. |
Give one additional dose of PCV13 to
children with underlying medical conditions that increase their risk
for developing pneumococcal disease or complications (see following
Q&A) who have not yet reached their sixth birthday. |
| 3. |
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For children ages 6 through 18 years
with functional or anatomic asplenia, including sickle cell disease,
HIV infection or other immunocompromising condition, cochlear
implant or CSF leak, consider giving one dose of PCV13 regardless of
previous history of PCV7 or pneumococcal polysaccharide vaccine
(PPSV). To view the full recommendations for PCV13, go to www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm. |
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| Which children are at
increased risk for invasive pneumococcal disease? |
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| Children who are at increased risk for
developing pneumococcal disease or complications are listed in the table
below: |
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| Risk Group |
Condition |
| Immunocompetent children |
Chronic heart disease
(particularly cyanotic congenital heart disease and cardiac failure) |
| Chronic lung disease
(including asthma if treated with prolonged high-dose oral
corticosteroids) |
| Diabetes mellitus |
| Cerebrospinal fluid leak |
| Cochlear implant |
| Children with functional or
anatomic asplenia |
Sickle cell disease and
other hemoglobinopathies |
| Congenital or acquired
asplenia, or splenic dysfunction |
| Children with
immunocompromising conditions |
HIV infection |
| Chronic renal failure
and nephrotic syndrome |
| Diseases associated with
treatment with immunosuppressive drugs or radiation therapy (e.g.,
malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; or
solid organ transplantation) |
| Congenital
immunodeficiency (includes B- (humoral) or T-lymphocyte deficiency;
complement deficiencies, particularly C1, C2, C3, and C4 deficiency;
and phagocytic disorders (excluding chronic granulomatous disease) |
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| What vaccination schedule should we
use now? |
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| The table below can help guide the
vaccination of infants and children who are in various stages of PCV
vaccination (i.e., unvaccinated, begun a series of PCV7 or PCV13 but not
yet completed, or have completed a series of PCV7). |
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Recommended Schedules for Administering
Pneumococcal Conjugate Vaccine (PCV) to Children
By PCV Vaccination History and Age |
| Child's age now |
Vaccination History of PCV7 and/or PCV13 |
Recommended PCV13
Schedule
(see footnote* below for minimum intervals between doses) |
| 2 through 6 months |
0 dose |
3 doses, 8 weeks apart; 4th dose at age
12-15 months |
| 1 dose |
2 doses, 8 wks apart; 4th dose at age
12-15 months |
| 2 doses |
1 dose, at least 8 weeks after the most
recent dose; dose #4 at age 12-15 months |
| 7 through 11 months |
0 doses |
2 doses. 8 wks apart; dose #3 at age
12-15 months |
| 1 or 2 doses before age 7 months |
1 dose at age 7-11 months, with a second
dose at age 12-15 months (8 wks later) |
| 12 through 23 months |
0 doses |
2 doses, at least 8 weeks apart |
| 1 dose before age 12 months |
2 doses, at least 8 weeks apart |
| 1 dose at or after age 12 months |
1 dose, at least 8 weeks after the most
recent dose |
| 2 or 3 doses before age 12 months |
1 dose, at least 8 weeks after the most
recent dose |
| 4 doses of PCV7 or other
age-appropriate, complete PCV7 schedule |
1 supplemental dose, at least 8 weeks
after the most recent dose |
24 through 59 months
(healthy) |
Unvaccinated or any incomplete
schedule |
1 dose, at least 8 weeks after the most
recent dose |
| 4 doses of PCV7 or other
age-appropriate, complete PCV7 schedule |
1 dose, at least 8 weeks after the most
recent dose |
24 through 71 months
(with risk factor) |
Unvaccinated or any incomplete
schedule |
2 doses, one at least 8 weeks after the
most recent dose and another dose at least 8 weeks later |
| Any incomplete schedule of 3 doses |
1 supplemental dose, at least 8 weeks
after the most recent dose |
| 4 doses of PCV7 or other
age-appropriate complete PCV7 schedule |
1 supplemental dose, at least 8 weeks
after the most recent dose |
| * |
The
minimum interval between doses of PCV7 or PCV13 administered at
younger than 12 months of age is 4 weeks. The minimum interval for
the next-to-last to last dose is 8 weeks. |
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| Many children in my practice have
received their complete series of 7-valent pneumococcal conjugate
vaccine (PCV7). Would you please review the recommendations for which of
them now need a supplemental dose of 13-valent pneumococcal conjugate
vaccine (PCV13)? |
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| A single supplemental dose of PCV13 is
recommended for all children ages 14 through 59 months who have received
the complete 4-dose series of PCV7 or another age-appropriate, complete
PCV7 schedule. For children who have underlying medical conditions, a
single supplemental PCV13 dose is recommended through age 71 months.
This also includes children who have previously received pneumococcal
polysaccharide vaccine (PPSV23). Give the single supplemental dose of
PCV13 no sooner than 8 weeks after the last dose of PCV7 or PPSV23 was
given.
IAC has created a table that explains
how to use PCV13 to catch up children who have fallen behind on their
PCV7 doses. It's available at www.immunize.org/catg.d/p2016.pdf |
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| I have a 13-year-old patient in my
practice who recently had his spleen removed. He has been vaccinated
with pneumococcal polysaccharide vaccine (PPSV23) but never received
7-valent pneumococcal conjugate vaccine (PCV7). Can I give him the new
13-valent pneumococcal conjugate vaccine, PCV13? |
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| Yes. Administer a single dose of PCV13
to children ages 6 through 18 years who are at increased risk for
invasive pneumococcal disease because of sickle cell disease, HIV
infection or other immunocompromising condition, cochlear implant,
functional or anatomical asplenia, or cerebrospinal fluid leak, even if
they have previously received PCV7, PPSV23, or both vaccines. A table
that details the underlying medical conditions that are indications for
pneumococcal vaccination among children is available on page 260 of the
related ACIP recommendations at www.cdc.gov/mmwr/PDF/wk/mm5909.pdf |
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| Can PCV13 be used in older children? |
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| Neither ACIP nor AAP recommend routine
vaccination with PCV13 for healthy children 5 years of age or older.
ACIP does, however, recommend routine vaccination of high risk children
through age 5 years (i.e., through age 71 months). ACIP also states that
provider's may administer a single dose of PCV13 to children ages 6
through 18 years who are at increased risk for invasive pneumococcal
disease because of functional or anatomic asplenia, including sickle
cell disease, HIV infection or other immunocompromising condition,
cochlear implant or CSF leak. |
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| Do children who are diagnosed with
pneumococcal disease still need to receive pneumococcal conjugate
vaccine? |
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| Yes. There are several different
serotypes of Streptococcus pneumoniae that cause disease in children. A
child who has had pneumococcal disease has only developed antibody
against one serotype. |
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| How should we administer both
pneumococcal vaccines (PCV13 and PPSV) to our high risk pediatric
patients? |
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| All children with risk factors for
pneumococcal disease or its complications should be vaccinated with PPSV
beginning at age 2 years. If they are age-eligible and are due for a
dose of PCV13, give that one first and then wait 8 weeks before giving
PPSV. For more information on vaccination of high risk pediatric
patients, see the ACIP statement at www.cdc.gov/mmwr/PDF/rr/rr4909.pdf (p. 26-27). |
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| A 2-month-old was mistakenly given
PPSV instead of PCV13. What should be done? |
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| PPSV is not effective in children less
than 24 months of age. PPSV given at this age should not be considered
to be part of the pneumococcal vaccination series. PCV13 should be
administered as soon as the error is discovered. Any time the wrong
vaccine is given, the parent/patient should be notified. |
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| When should a child undergoing a
splenectomy receive pneumococcal vaccine(s)? |
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| It is preferable that the child have
antibody to pneumococcus at the time of the surgery, so if possible
administer the appropriate vaccine prior to splenectomy. Children 2
through 71 months of age should continue to receive PCV vaccine
according to the schedule above. If the splenectomy is done on an
emergency basis, vaccinate as soon as possible according to the routine
schedule. Administer a dose of PPSV to all splenectomized children 2
years of age and older with an interval of at least 8 weeks from the
previous dose of PCV. |
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| Reviewed on 8/10 |
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