Pneumococcal Conjugate Vaccine

Aka: Pneumococcal Conjugate Vaccine, Heptavalent Pneumococcal Conjugate Vaccine, Prevnar

1. Indications: Pediatric Vaccine
   1. Primary Immunization series for young children
2. Pharmacology
   1. Now contains 13 serotypes (Prevnar-13)
      1. Replaces the Prevnar-7 and includes the prior serotypes and 6 new ones
      2. Prior seven valent vaccine covered serotypes most affecting children
         1. Serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F
         2. These serotypes are responsible for >80% of Meningitis and bacteremia in age <6 years
   2. Components
      1. Pneumococcal polysaccharide conjugated to non-toxic Diphtheria toxin
   3. Differs from the adult vaccine (Pnu-Imune 23)
      1. Prevnar is more immunogenic
      2. Prevnar does not contain Thimerosal
3. Importance of vaccine
   1. Infections caused by Streptococcus Pneumoniae (age <6)
      1. Community acquired Pneumonia (leading cause)
      2. Otitis Media (leading cause)
      3. Bacterial Meningitis (leading cause)
      4. Streptococcus bacteremia
   2. Antibiotic Resistance is growing
      1. Penicillin Resistant Pneumococcus now 24% of isolates
4. Efficacy: Highly effective
   1. Prevents 94-97% invasive disease by immunized serotypes
   2. Decreases Acute Otitis Media episodes in infants
5. Adverse Effects
   1. No serious adverse effects
   2. Fever to 38 F
   3. Local inflammation at injection site
6. Dosing: Regular Schedule started in infancy
   1. Four doses: 2, 4, 6 and 12 to 15 months
7. Dosing: Catch up dosing based on age at first dose
   1. Age 2 to 6 months
      1. Primary Series: 3 doses, two months apart
      2. Booster: 12 to 15 months
   2. Age 7 to 11 months
      1. Primary Series: 2 doses, two months apart
      2. Booster: 12 to 15 months
   3. Age 12 to 23 months
      1. Primary Series: 2 doses, two months apart
   4. Age 24 to 59 months in healthy child
      1. Primary Series: one dose
   5. Age 24 to 59 months in child with chronic illness
      1. Indicated conditions
         1. Sickle Cell Anemia
         2. Asplenic patient
         3. HIV Infection
         4. Other chronic illness
         5. Immunocompromising condition
      2. Primary Series: two doses, two months apart
   6. Age 5 years and older
      1. Vaccination not recommended
8. References
   1. Black (2000) Pediatr Infect Dis J 19:187-95
   2. Eskola (2001) N Engl J Med 344:403-9
   3. Rennels (1998) Pediatrics 101(4 pt 1):604-11
   4. Shinefield (1999) Pediatr Infect Dis J 18:757-63
   5. Zimmerman (2001) Am Fam Physician 63(10):1991-2004
   6. (2000) MMWR Morb Mortal Wkly Rep 49(RR-9):1-35