Pneumococcal Vaccine

Sayenna Uduman
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Immunization Schedules for PCV vaccines
Indian Academy of Pediatrics Immunization Schedule recommends:
• For routine immunization both PCV10 and PCV13 are licensed for children from 6 weeks to 5 years of age.
• Primary schedule (for both PCV10 and PCV13): 3 primary doses at 6, 10, and 14 weeks with a booster at age 12 through 15 months.
• Additionally, PCV13 is licensed for the prevention of pneumococcal diseases in adults > 50 years of age.

CDC, ACIP Guidelines (North America, Mid East, most Euros’ countries):
• PCV13 is recommended for routine immunization for healthy children at 2, 4, 6, and 12 to 15 months of age.
• Children who miss their shots at these ages should still get the vaccine. The number of doses and the intervals between doses will depend on the child’s age. The recommended Schedule for number of doses of PCV13, including Catch-up immunizations in previously unimmunized and partially immunized children 24-71 months of age is shown in Table 1.

Table 1: PCV doses-schedule, Including Catch-up Immunizations in Previously Unimmunized and Partially Immunized Children
Age (months ) Immunization status Recommended No. of doses to given & the time interval
2-6 Had 0 dose 3 doses : 2 months apart; 4th at 12 - 15 months
Had 1 dose 2 doses : 2 months apart; 4th at 12 -15 months
Had 2 doses 1 dose : 2 months after the most recent dose; 4th at 12 - 15 months
7-11 Had 0 dose 2 doses, 2 months apart; third dose at 12 months of age
12- 23 Had 0 dose 2 doses, 2 months apart
Had 1 dose at <12months 2 doses, 2 months apart
Had 1 dose at 12 months 1 dose, 2 months after the most recent dose
Had 2 or 3 doses at <12 months 1 dose, 2 months after the most recent dose


Catch-up Vaccination with PCV13
• Administer 1 dose of PCV13 to all healthy children aged 24 through 71 months who are not completely vaccinated for their age. (Redbook)
• Children with underlying medical conditions younger than 72 months of age who were previously fully immunized with PCV7 should receive one dose of PCV13.
• Older children with immune compromise and other specific high-risk conditions for invasive disease (e.g., cochlear implants, cerebrospinal fluid leaks, hemoglobinopathies and asplenia) should be immunized with two dose of PCV13 if not previously immunized.
• For high risk clinical condition, consider 2 doses of PCV13 at least 8 weeks apart if unvaccinated or any incomplete schedule of fewer than 3 doses of PCV that were received previously.

• Not recommended for routine use in infant immunization & healthy individuals (not immunogenic < 2 years, T cell independent)
• Recommended only for the vaccination of persons with certain high-risk conditions.
• Single dose for all adults 65 years and older. People with certain chronic health conditions may be recommended to receive a second dose, five years after their first dose.
• If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 8 weeks after the most recent dose of PPSV23.
• Vaccination of persons with high-risk conditions: All recommended PCV13 doses should be administered prior to PPSV23 vaccination if possible.

PPSV23 should never be used alone for prevention of pneumococcal diseases amongst high-risk individuals. Children with following medical conditions for which PPSV23 and PCV are indicated in the age group 24 through 71 months:
• Children with anatomic or functional asplenia (including sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, or splenic dysfunction)
• Immune competent children with congenital heart disease (particularly cyanotic type and cardiac failure); chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy), diabetes mellitus; cerebrospinal fluid leaks; or cochlear implant.
• Children with immune compromising conditions: HIV infection, Nephrotic syndrome and chronic renal failure, diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms or solid organ transplantation, congenital immunodeficiency.

• One dose of PCV13 is recommended for grown-up children 6 through 18 years of age and adults 19 through 64 years of age with the following medical conditions that put them at high risk for IPD.
    • Functional or anatomic asplenia
    • Congenital or acquired immunodeficiency
    • Nephrotic syndrome
    • Chronic renal failure
    • Chronic lung disease including asthma
    • Cochlear implant(s)
    • Sickle cell disease and other hemoglobinopathies
    • Malignant conditions & long-term immunosuppressive therapy
    • Solid Organ transplant
• Adults 50 years of age or older with one of the above listed conditions who have not received any pneumococcal vaccine, should get a dose of PCV13 first and a dose of PPSV23 should be given 6 to 12 months later.
• For adults 50 years and older who have already received one or more doses of PPSV23, the dose of PCV13 should be given at least one year after receiving the most recent dose of PPSV23.
Most healthy adults who get the vaccine develop protection to most or all of these types within two to three weeks of getting the shot. Very old people and people with some long-term illnesses might not respond as well, or at all.

• Pneumococcal containing combination (Combo’s) Vaccine are not manufactured and approved for clinical use.
• Concomitant administration of PCV13 and trivalent inactivated influenza vaccine (TIV) has been demonstrated to be immunogenic and safe. The PCV13 can be co-administered with TIV in an adult immunization program.
• Currently, no data are available on co-administration with other vaccines (e.g., tetanus, diphtheria, and acellular pertussis vaccine or zoster vaccine) both among children and adults.

Both PCV vaccines are available as pre-filled syringe and given 0.5ml intramuscularly. PPSV23 is given subcutaneously. The preferred sites are the anterolateral aspect of the thigh in infants or the deltoid muscle of the upper arm in older children and adults.

Storage: PCV should not be frozen. Store in a refrigerated place, away from the freezer compartment, at 2oC to 8oC. Discard if the vaccine has been frozen. Parenteral products should be inspected visually for particulate matter or discoloration prior to use.

References
Pneumococcal Vaccine Pneumococcal Vaccine 11/10/2017
<< Types of Pneumococcal Vaccines Precautions and Contraindications >>
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