Infants between the ages of 1 and 6 months who have never received any PCV product should complete a series of PCV13 at 2, 4, 6, and 12 to 15 months—the same time line as the PCV7 series.
Children ages 7 to 59 months who have not been vaccinated with PCV7 or PCV13 previously should receive 1 to 3 doses of PCV13, depending on their age at the time when vaccination begins and whether underlying medical conditions are present (TABLE 3).
Healthy children ages 24 to 59 months without previous PCV vaccine should receive 1 dose of PCV13.
Children ages 24 to 71 months without previous PCV vaccine who have a chronic medical condition that increases their risk for pneumococcal disease should receive 2 doses of PCV13, 8 weeks apart.1
TABLE 3
Underlying conditions that place kids at risk for pneumococcal disease
| Risk group | Condition |
|---|---|
| Immunocompetent children | Chronic heart disease* |
| Chronic lung disease† | |
| Diabetes mellitus | |
| Cerebrospinal fluid leaks | |
| Cochlear implant | |
| Children with functional or anatomic asplenia | Sickle cell disease and other hemoglobulinopathies |
| Congenital or acquired asplenia or splenic dysfunction | |
| Children with immunocompromising conditions | HIV infection |
| Chronic renal failure and nephrotic syndrome | |
| Diseases associated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin’s disease; or solid organ transplantation | |
| Congenital immunodeficiency‡ | |
| *Particularly cyanotic congenital heart disease and cardiac failure. | |
| †Including asthma if treated with prolonged high-dose oral corticosteroids. | |
| ‡Includes B- (humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease). | |
| Source: CDC. MMWR Morb Mortal Wkly Rep. 2010.1 | |
Recommendations for children at higher risk
Provisional recommendations from ACIP advise that children 2 through 18 years of age at increased risk for invasive pneumococcal disease should also receive 23-valent pneumococcal polysaccharide vaccine (PPSV23). Ideally, the child should have received all of the recommended doses of PCV13 before the physician administers PPSV23, with a minimum interval of at least 8 weeks after the last dose of PCV13.
However, some children will have previously received PPSV23. They should also receive the recommended PCV13 doses. A second dose of PPSV23 is recommended 5 years after the first dose of PPSV23 for children who have sickle cell disease, or functional or anatomic asplenia, human immunodeficiency virus (HIV) infection, or other immunocompromising conditions. No more than 2 PPSV23 doses are recommended.9
The ACIP provisional recommendations also say that a single dose of PCV13 may be administered to children ages 6 to 18 years who are at increased risk for IPD because of sickle cell disease, HIV infection or other immunocompromising condition, cochlear implant, or cerebrospinal fluid leaks, regardless of whether they have previously received PCV7 or PPSV23.9 This, however, is an off-label recommendation.
The usual contraindications
PCV13 is contraindicated among individuals known to have a severe allergic reaction to any component of PCV13 or PCV7 or to any diphtheria toxoid-containing vaccine, because the pneumococcal antigens are conjugated to a diphtheria carrier protein.1
A useful vaccine, with its share of challenges
The pneumococcal conjugate vaccine combats infections such as pneumococcal pneumonia and meningitis, which are potentially serious—even though their incidence is relatively low.
The vaccine’s high private-sector cost—reported by the manufacturer to the CDC as $435 for the full, 4-dose series of PCV13—can be a drawback for the family physician trying to keep a full array of vaccine products on hand.10 Eligible low-income and uninsured children can receive free vaccine under the federal Vaccines for Children Program, and providers who choose to enroll in the program can access free vaccines and may charge for the expense of administering them.11
With this hurdle overcome, the remaining challenge for physicians will be to stay on top of the complicated dosing schedule.