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| What
causes pneumococcal disease? |
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| Pneumococcal disease is caused by
Streptococcus pneumoniae, a bacterium that has more than 90 serotypes.
Most serotypes cause disease, but only a few produce
the majority of invasive pneumococcal disease. The 10 most common
types cause 62% of invasive disease worldwide. |
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| How does pneumococcal disease
spread? |
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| The disease is spread from person to
person by droplets in the air. The pneumococci bacteria are common
inhabitants of the human respiratory tract. They may
be isolated from the nasopharnyx of 5%-70% of normal, healthy adults. |
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| How long does it take to show signs
of pneumococcal disease after being exposed? |
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| As noted above, many people carry the
bacteria in their nose and throat without ever developing invasive
disease. The incubation period for specific diseases
caused by an invasive pneumococcal infection is noted below. |
| |
| What are the types of invasive
pneumococcal disease? |
|
| There are two major clinical syndromes
of invasive pneumococcal disease: bacteremia, and meningitis. They are
both caused by infection with the same
bacteria, but have different manifestations.
Pneumococcal pneumonia is the most
common disease caused by pneumococcal infection. Pneumococcal
pneumonia can occur in combination with bacteremia and/or
meningitis, or it can occur alone. Isolated pneumococcal pneumonia
is not considered invasive disease but it can be severe. It is
estimated that 175,000
cases occur each year in the United States. The incubation period is
short (1-3 days). Symptoms include abrupt onset of fever, shaking
chills or rigors,
chest pain, cough, shortness of breath, rapid breathing and heart
rate, and weakness. The fatality rate is 5%-7% and may be much
higher in the elderly.
Pneumococcal bacteremia occurs in
about 25%-30% of patients with pneumococcal pneumonia. More than
50,000 cases of pneumococcal bacteremia occur each year in
the United States. Bacteremia is the most common clinical
presentation among children less than two years, accounting for 70%
of invasive disease in this
group.
Pneumococci cause 13%-19% of all
cases of bacterial meningitis in the United States. There are
3,000-6,000 cases of pneumococcal meningitis each year.
Symptoms and signs may include headache, tiredness, vomiting,
irritability, fever, seizures, and coma. Children less than one year
have the highest rate of
pneumococcal meningitis, approximately 10 cases per 100,000
population. The mortality rate is high (30% overall, up to 80% in
the elderly). |
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| How serious is pneumococcal disease
in the U.S? |
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| Pneumococcal disease is a serious
disease that causes much sickness and death. In fact, pneumococcal
disease kills more people in the United States each year
than all other vaccine-preventable diseases combined.
More than 40,000 cases and more than
4,000 deaths from invasive
pneumococcal diseases (bacteremia and meningitis) are estimated to
have occurred in the
United States in 2007. More than half of these cases occurred in
adults who had an indication for pneumococcal polysaccharide
vaccine. Young children and the
elderly (younger than age five years and older than 65) have the
highest incidence of serious disease.
Case-fatality rates are highest for
pneumococcal meningitis and bacteremia, and the highest mortality occurs among
the elderly and patients who have underlying medical
conditions. Despite appropriate antimicrobial therapy and intensive
medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20%
among adults. Among elderly patients, this rate may be as high as 60%. |
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| Pneumococcal
polysaccharide vaccine (PPSV23) |
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| When were the first vaccines
licensed for vaccination against pneumococcal disease? |
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| The first pneumococcal vaccine,
licensed in 1977, was a polysaccharide vaccine. It contained purified
capsular polysaccharide antigen from 14 different
types of pneumococcal bacteria. In 1983, a 23-valent polysaccharide
was licensed (PPSV23). It replaced the 14-valent vaccine. |
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| Recommendations for
primary PPSV23 vaccination |
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| For whom is the 23-valent
pneumococcal polysaccharide vaccine (PPSV23) recommended? |
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| PPSV23 vaccine is recommended for all
people who meet any of the criteria below: |
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| 1. |
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All adults age 65 yrs and
older |
| 2. |
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Age 2 through 64 yrs
with any of the following conditions: |
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a. |
cigarette
smokers age 19 yrs and older |
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b. |
chronic cardiovascular disease
(e.g., congestive heart failure, cardiomyopathies; excluding
hypertension) |
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c. |
chronic pulmonary disease
(including COPD and emphysema, and for adults ages 19 years and
older, asthma) |
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d. |
diabetes
mellitus |
| |
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e. |
alcoholism |
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f. |
chronic liver disease,
cirrhosis |
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g. |
candidate
for or recipient of cochlear implant |
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h. |
cerebrospinal fluid (CSF) leak |
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i. |
functional or anatomic
asplenia (e.g., sickle cell disease, splenectomy) |
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j. |
immunocompromising conditions (e.g., HIV infection, leukemia,
congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple
myeloma, generalized
malignancy) or on immunosuppressive therapy |
| |
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k. |
solid organ transplantation; for
bone marrow transplantation, see
www.cdc.gov/vaccines/pubs/hemato-cell-transplts.htm. |
| |
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l. |
chronic renal failure or
nephrotic syndrome |
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| Public health authorities may also
consider recommending PPSV23 for Alaska Natives and American Indians
ages 50 through 64 years who are living in areas in
which the risk of invasive pneumococcal disease is increased. |
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| Which children should receive
PPSV23 vaccine (in addition to PCV13)? At what age should they receive
it? |
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| PPSV23 is recommended for children
with an immunocompromising condition, or functional or anatomic
asplenia, and also for immunocompetent children with
chronic heart disease, chronic lung disease, diabetes mellitus,
cerebrospinal fluid leak, or cochlear implant. Administer 1 dose of
PPSV23 to children age 2
years and older at least 8 weeks after the child has received the
final dose of PCV13. Children with an immunocompromising condition, or
functional or
anatomic asplenia should receive a second dose of PPSV23 5 years after
the first PPSV23. |
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| Can you please explain when and why
the recommendations for vaccination were changed for people with
asthma and for cigarette smokers? |
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| The 1997 CDC recommendations for the
use of PPSV exclude asthma in the chronic pulmonary disease category
because no data on increased risk of pneumococcal
disease among people with asthma were available when the
recommendation was issued. In 2008, the Advisory Committee on
Immunization Practices (ACIP) reviewed
new information that suggests that asthma is an independent risk
factor for pneumococcal disease among adults. ACIP also reviewed new
information that
demonstrates an increased risk of pneumococcal disease among smokers.
Consequently, ACIP recommends to include both asthma and cigarette
smoking as risk
factors for pneumococcal disease among adults age 19 through 64 years
and as indications for PPSV23. |
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| Since PPSV23 is recommended for all
adults who smoke, should adults who use smokeless tobacco products
(e.g., chewing tobacco) be vaccinated too? |
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| No. ACIP does not identify people who
use smokeless tobacco products as being at increased risk for
pneumococcal disease or as being in a risk group for
vaccination. |
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| In its September 2010 publication
of updated recommendations for prevention of invasive pneumococcal
disease among adults, ACIP recommends vaccinating adult
asthmatics with PPSV23. Should I give PPSV23 to people with mild,
intermittent asthma or exercise-induced asthma? Why isn't PPSV23
recommended for asthmatic
children? |
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| PPSV23 is recommended for adults 19
years and older with all types of asthma. Available data do not
indicate that asthma alone increases the risk of invasive
pneumococcal disease among people younger than 19 years, so PPSV23 is
not currently recommended for people younger than 19 years with
asthma. For more
information, go to
www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm. |
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| Should people who are HIV positive
receive pneumococcal vaccines? |
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| Yes. People with HIV infection should
receive both PCV13 and PPSV23 vaccines as soon as possible after
diagnosis. They should first be given PCV13, followed
by PPSV23 8 weeks later. If they are younger than age 65 years, they
will need a second dose of PPSV23 at least 5 years after their initial
dose and a third
dose once they become age 65 years. If they are age 65 years or older
when first diagnosed, they will need only one dose. The risk of
pneumococcal infection
is up to 100 times greater in HIV-infected people than in other adults
of similar age. Although severely immunocompromised people may not
respond well to the
vaccine, and there is a chance that the vaccine may not produce an
antibody response, the risk of disease is great enough to warrant vaccination. |
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| How often should diabetic patients
receive pneumococcal polysaccharide vaccine? |
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| People with diabetes who are ages 2
through 64 years who have not already received a dose of PPSV23 should
receive their first dose now. At age 65 years they
should receive a one-time revaccination if 5 years have elapsed since
the previous dose. |
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| How often should adult dialysis
patients receive pneumococcal polysaccharide vaccine? |
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| Adult dialysis patients younger than
age 65 years need a dose of PPSV23 followed by a second dose 5 years
later; once they become 65, they will need another
dose. If they were age 65 years or older when first vaccinated, only
one dose of PPSV23 is recommended. |
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| Is there any reason to withhold
pneumococcal vaccine from a healthy non-smoking 45-year old who
requests it to decrease his/her risk of this disease? |
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| No, although ACIP does not routinely
recommend pneumococcal vaccine for healthy people of this age. |
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| Could you briefly summarize the
recommendations for PPSV23 revaccination? |
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| Revaccination 5 years after the first
dose of PPSV23 is recommended for 1) children and adults younger than
age 65 years at highest risk for serious pneumococcal infection or who
are likely to have a rapid decline in antibody levels (see next Q&A)
and 2) adults age 65 years and older who received their first dose for
any indication when they were younger than age 65 years. Adults who
receive PPSV23 at or after age 65 years should receive only a single
dose. |
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| Which adults ages 19—64 years
should receive a second dose of PPSV23? |
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| A second PPSV23 given 5 years after
the first dose is recommended for people age 19 through 64 years who
have functional or anatomic asplenia (including persons with sickle
cell disease or splenectomy patients); chronic renal failure
(including dialysis patients) or nephrotic syndrome; are
immunocompromised, including those with HIV infection, leukemia,
lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy;
are receiving immunosuppressive therapy (including long-term systemic
corticosteroids or radiation therapy); or who have received a solid
organ transplant. |
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| Do patients who were vaccinated with one or two doses of PPSV23 before
age 65 need an additional dose of PPSV23 at age 65 or later? |
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| Yes. Patients who received PPSV23 for any indication at age 64 years
or younger should receive an additional dose of PPSV23 vaccine at age
65 years or older if at least 5 years have elapsed since their
previous PPSV23 dose. |
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| Should a healthy 75-year-old
patient who was given PPSV at age 65 years be revaccinated? |
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| No. Adults who were first vaccinated
at age 65 years or older need only one dose. |
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| I've heard pneumococcal
polysaccharide vaccine (PPSV23) isn't very effective in older people.
Should I still use it? |
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| Yes. PPSV23 vaccine is 60%-80%
effective against invasive pneumococcal disease when it is given to
immunocompetent people age 65 years and older or people with chronic
illnesses. The vaccine is less effective in immunodeficient people.
So, although PPSV23 is not as effective as some other vaccines, it can
significantly lower the risk of serious pneumococcal disease and its
complications in most recipients. |
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| My patient has had
laboratory-confirmed pneumococcal pneumonia. Does he/she still need to
be vaccinated with PPSV23? |
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| Yes. There are more than 90 known
serotypes of pneumococcus (23 serotypes are in the current vaccine).
Infection with one serotype does not necessarily produce immunity to
other serotypes. As a result, if the person is a candidate for
vaccination, s/he should receive it even after one or more episodes of
invasive pneumococcal disease. |
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| If influenza is recommended for
healthcare workers to protect high-risk patients from getting
influenza, why isn't the pneumococcal polysaccharide vaccine also
recommended? |
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| Influenza virus is easily spread from
healthcare workers to their patients, and infection usually leads to
clinical illness. Pneumococcus is probably not spread from healthcare
workers to their patients as easily as is influenza, and infection
with pneumococcus does not necessarily lead to clinical illness. Host
factors (such as age, underlying illness) are more important in the
development of invasive pneumococcal disease than nasopharyngeal
colonization with the organism. When you're giving influenza vaccine
to your patients in the fall, don't forget to assess their need for
pneumococcal vaccine as well as all other vaccines. |
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| When were the first conjugate
vaccines licensed? |
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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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PCV7 was initially recommended for
routine use in infants and children ages 2 through 59 months. The
recommendations were expanded with the licensure of PCV13 to include
vaccination of children age 60 through 71 months with underlying
medical conditions, and also permissive recommendations to consider
vaccination of older children, ages 6 through 18 years, with medical
conditions placing them at increased risk of invasive pneumococcal
disease. In late 2011, a supplement was issued to the FDA license
for expanded use of PCV13 in adults. |
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| What are the recommendations for
routine vaccination of children with PCV13? |
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| All infants should be given a primary
series of PCV13, at ages 2, 4, and 6 months with a booster at age 12
to 15 months. Children who fall behind should be given catch-up
vaccination through age 59 months, if otherwise healthy or, through
age 71 months if they have certain underlying medical conditions. |
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| What are the recommendations for
vaccinating children who previously received PCV7? |
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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). |
|
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 is available at
www.immunize.org/catg.d/p2016.pdf. |
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Vaccination with PCV13 in
adults with medical conditions |
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| Which adults are now recommended to
receive a dose of PCV13? |
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Adults age 19 years and older who have
the conditions specified below and who have not previously received
PCV13 should receive a PCV13 dose during their next vaccination
opportunity.
| • |
Immunocompromising
conditions (e.g., congenital or acquired immunodeficiency, HIV,
chronic renal failure, nephrotic syndrome, leukemia, lymphoma,
Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, and multiple myeloma) |
| • |
Functional or anatomic
asplenia (e.g., sickle cell disease and other hemoglobinopathies
and congenital and acquired asplenia) |
| • |
Cerebrospinal fluid (CSF) leak |
| • |
Cochlear implants |
|
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| Can we administer either the
pneumococcal polysaccharide or the pneumococcal conjugate vaccine to
patients with multiple sclerosis? |
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| Multiple sclerosis is not a
contraindication to any vaccine, including either of the pneumococcal
vaccines. |
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| A 2-month-old was mistakenly given
PPSV23 instead of PCV13. What should be done? |
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| PPSV23 is not effective in children
less than 24 months of age. PPSV23 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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| 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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| Vaccination
scheduling and documentation issues |
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| During an office visit, can a
healthcare provider administer PCV13 and PPSV23 to an adult patient
who needs both vaccines but who has had neither? If not, what is the
recommended interval between doses? |
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| PCV13 and PPSV23 should not be given
at the same visit. Patients who need both PCV13 and PPSV23 and who
have received neither should receive PCV13 first, followed by a dose
of PPSV23 at least 8 weeks later. If a second PPSV23 dose is
recommended, it should be administered at least 5 years after the
first PPSV23 dose. |
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| What is the recommended interval
between doses for adult patients who have already received one dose of
PPSV23 and now need PCV13? |
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| For patients who have already had one
or more doses of PPSV23, it is recommended to wait 1 year or more
after PPSV23 before administering PCV13. If the patient is recommended
to receive a second dose of PPSV23, delay that second PPSV23 dose for
8 weeks or more following PCV13 and 5 years or more following the
first dose of PPSV23. |
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| If patients who are in a
recommended risk group for PPSV23 or PCV13 aren't sure if they have
previously received these vaccines, should healthcare providers
vaccinate them? |
|
| Yes. If patients do not have a
documented vaccination history for these two vaccines and their
records are not readily obtainable, you should administer the
recommended doses. Extra doses will not cause harm to the patient. |
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| We just gave PPSV23 to a
66-year-old patient who is newly diagnosed with a medical condition
that places him at increased risk for pneumococcal disease and its
complications. Should we give him a second dose in 5 years because of
his underlying medical condition? |
|
| No. People who are first vaccinated
with PPSV23 at age 65 years or older should receive only one dose,
regardless of any underlying medical condition they might have. |
|
| When should I vaccinate children or
adults who are planning to have either a cochlear implant or elective
splenectomy? |
|
| It is preferable that the person
planning to have the procedure have antibody to pneumococcus at the time of
the surgery; if possible, administer the appropriate vaccine prior to
the splenectomy or cochlear implant. Children 2 through 71 months of
age should continue to receive PCV13 vaccine according to the schedule
above. If the procedure is done on an emergency basis, vaccinate as
soon as possible according to the routine schedule. Administer a dose
of PPSV23 to all patients with an interval of at least 8 weeks from
the previous dose of PCV13. |
|
| How should we administer both
pneumococcal vaccines (PCV13 and PPSV23) to our high risk pediatric
patients? |
|
| 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 pages 26—27 of the ACIP statement at
www.cdc.gov/mmwr/PDF/rr/rr4909.pdf. |
|
| Some physicians in our area order
PPSV23 every 5 years for their patients. Is this correct? |
|
| No. Only certain high-risk people who
were vaccinated when younger than age 65 years will need a second dose
5 years later. At age 65 years, all adults (including people
vaccinated when younger) will need to be vaccinated. |
|
| Can we vaccinate a 2-year-old boy
with functional or anatomic asplenia against meningococcal disease if
he has not completed a series of PCV13? |
|
| You should first be certain that he is
up to date with PCV13 vaccine before you vaccinate him with MCV4. If
you are going to give him MCV4-D (Menactra; sanofi pasteur), you need
to wait at least 4 weeks after he completes the PCV13 series before
giving him the MCV4-D. There is no similar space consideration if
MCV4-CRM (Menveo; Novartis) is used; it may be given simultaneously
with PCV13 or at any interval since receipt of PCV13. |
|
| Can I give other vaccines at the
same time I give either PCV13 or PPSV23 to a patient? |
|
Yes, with several exceptions. PPSV23
and PCV13 are both inactivated vaccines, which means you can give all
other recommended vaccines at the same visit (using separate syringes)
or at any later time with no waiting period following the vaccination.
Here are the exceptions:
| a. |
You cannot give both
PCV13 and PPSV23 at the same time. (Read next Q&A) |
| b. |
If the person is a
candidate for both meningococcal conjugate vaccine (MCV4) and
PCV13, observe these rules: |
| |
• |
If using
MCV4-D (Menactra by sanofi), you should give PCV13 first with a 4
week separation between the final dose of PCV13 and MCV4-D. |
| |
• |
If using MCV4-CRM (Menveo by
Novartis): give both products simultaneously or at any other
interval |
|
|
| What intervals should be observed
between doses of PCV13 and PPSV23 for those children and adults who
are recommended to receive both vaccines? |
|
| In these situations, give PCV13 first
followed by PPSV23 in 8 weeks. If PPSV23 has already been given, wait
1 year before giving PCV13 to avoid interference between the 2
vaccines. |
|
| The Zostavax vaccine (Merck)
package insert says that Zostavax should not be given simultaneously
with pneumococcal polysaccharide vaccine (PPSV23). What does ACIP say
about this? |
|
| ACIP has not changed its
recommendation on the simultaneous administration of these two
vaccines (i.e., they can be given at the same time or any time before
or after each other). |
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| We have begun a more aggressive
approach to vaccinating our high-risk patients against pneumococcal
disease. Do you have any suggestions on how we can improve our system? |
|
| Congratulations on your efforts to
increase your clinic's vaccination rates against this serious and
deadly disease. Health experts have found that influenza predisposes
individuals to bacterial community-acquired pneumonia, and studies
have shown that this is heightened during influenza pandemics. In June
2009, CDC issued interim guidance for use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in preparation for the circulation of
the pandemic H1N1 virus. Though the guidance does not change the
groups indicated for PPSV23 and/or PCV13 vaccination, it does remind
providers that many at-risk people younger than age 65 years and many
people who are age 65 and older have not yet been vaccinated and they
need to be. |
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|
| What route and needle length is
recommended for administration of pneumococcal polysaccharide vaccine? |
|
| Pneumococcal polysaccharide vaccine
may be given either by intramuscular (IM) or subcutaneous (SC)
injection. When administration is IM, choose needle length appropriate
to the person's age and body mass: toddlers age 2 yrs: 1–1¼" (anterolateral
thigh) or ⅝–1" (deltoid muscle); children ages 3–4 yrs: ⅝–1"
(deltoid) or 1–1¼" (anterolateral thigh); adults, a 1–1½"
needle. A ⅝" needle may be used in toddlers and children and for
adult patients weighing less than 130 lbs (60 kg) for IM injection in
the deltoid muscle only if the subcutaneous tissue is not bunched and
the injection is made at a 90-degree angle. When administration of
PPSV23 is SC, a ⅝" needle is recommended. |
|
| What route and needle length should
we use for administration of pneumococcal conjugate vaccine (PCV13)? |
|
| Pneumococcal conjugate vaccine (PCV13)
should be administered by the intramuscular (IM) route. Choose needle
length appropriate to the person's age and body mass: infants younger
than age 12 months: 1"; toddlers 1–2 yrs: 1–1¼" (anterolateral
thigh) or ⅝–1" (deltoid muscle); children ages 3–4 yrs: ⅝–1"
(deltoid) or 1–1¼" (anterolateral thigh); adults, a 1–1½"
needle. A ⅝" needle may be used in toddlers and children and for adult
patients weighing less than 130 lbs (60 kg) for IM injection in the
deltoid muscle only if the subcutaneous tissue is not bunched and the
injection is made at a 90-degree angle. |
|
| Reviewed on November 13. 2012 |
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