II. Indications

  1. Pediatric Vaccine
    1. Primary Immunization series for young children
    2. Also give Pneumovax 23 to high risk children >2 years old
      1. Administer Prevnar-7 at least 8 weeks before Pneumovax 23
      2. See Pneumovax 23 for indications in children
  2. Adult Vaccine
    1. Immunocompromised patients (e.g. HIV, Chemotherapy, Asplenia)
      1. Covered by Medicare Part B as of 2012 (CPT 90670)
      2. Should also be given two Pneumovax 23Vaccines five years apart
      3. Prevnar 13 recommended for immunocompromised patients as of 2012
        1. Offers better immunity in high risk patients
    2. Timing with Pneumovax 23 (recommended as of 2012 for immunocompromised adults)
      1. No prior Pneumovax
        1. Give Prevnar 13 at least 8 weeks before Pneumovax 23
      2. Prior Pneumovax
        1. Give Prevnar 13 at least one year after Pneumovax 23
    3. References
      1. (2012) Presc Lett 19(12): 69
  3. Older adults after age 65 years
    1. No prior Pneumovax 23
      1. Prevnar 13 after age 65 year birthday AND
      2. Pneumovax 23 at 6-12 months after Prevnar 13 dose
    2. Prior Pneumovax 23 after age 65 year birthday
      1. Prevnar 13 after age 65 year birthday
      2. No further Pneumovax 23 needed
    3. Prior Pneumovax 23 before age 65 year birthday
      1. Prevnar 13 after age 65 year birthday AND
      2. Pneumovax 23 at 6-12 months after Prevnar 13 dose AND 5 years after Pneumovax 23
    4. References
      1. (2014) Presc Lett 21(11): 63-64

III. Pharmacology

  1. Prevnar 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

IV. Efficacy: 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

V. Efficacy: Highly effective

  1. Prevents 94-97% invasive disease by immunized serotypes
  2. Decreases Acute Otitis Media episodes in infants
  3. Significant reduction in pneumococcal Meningitis since Vaccine introduction (esp. <2 years old)
    1. Hsu (2009) N Engl J Med 360(3): 244-56 [PubMed]

VI. Adverse Effects

  1. No serious adverse effects
  2. Fever to 38 F
  3. Febrile Seizure (esp. when combined with Influenza Vaccine)
  4. Local inflammation at injection site

VII. Dosing: Regular Schedule started in infancy

  1. Four doses: 2, 4, 6 and 12 to 15 months

VIII. 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

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