Pneumococcal immunization expanded to high-risk children and teens up to age 18

A single dose of PCV13 followed by a dose of PPSV23 = 8 weeks later recommended

WITH THE focus on preventive health, mass immunization is now being undertaken by many governments. One area of particular emphasis is the prevention of pneumonia particularly in highrisk children, adolescents and teenagers.

Pneumococcal immunization expanded to high-risk children and teens up to age 18A recent update published in the December 2014 issue of the Pediatrics journal by the American Academy of Pediatrics (AAP) on pneumococcal immunization recommends the use of pneumococcal conjugate vaccine (PCV) 13 to be administered to all high-risk children to be followed by pneumococcal polysaccharide valent (PPSV) 23 vaccine if they have not received the latter vaccine yet.

It is well recognized that the introduction of conjugate pneumococcal vaccines (initially PCV in conjugate pneumococcal vaccines (initially PCV in 2000, followed by PCV13 in 2010) has significantly reduced the incidence of invasive pneumococcal disease (IPD). Greatest benefit has been noted in children aged 2 to 59 months, but IPD still occurs in children aged 6 to 18 years of age if they have medical conditions or risk factors that increase their risk for IPD.

It has been reported that almost half of these cases are due to vaccine serotypes. The previous recommendation for PCV13 have included children aged 2 to 59 months and children with high-risk conditions aged =71 months (less than 6 years). The updated AAP key recommendations is to administer a single dose of PCV13 in children aged 6 to 18 years at elevated risk for IPD (which includes children with asplenia, sickle-cell disease, any immunocompromising condition such as HIV, chronic heart or lung disease, and diabetes mellitus) regardless of whether they have previously received PCV7 or PPSV23 (pneumococcal polysaccharide 23 valent vaccine).

The recommendation is to administer a single dose of PCV13 followed by a dose of PPSV23 =8 weeks later in high-risk children aged 6 to 18 years. A second dose of PPSV23 is to be given five years after the first dose in all high-risk children aged 6 to 18 years. those with cerebrospinal fluid leaks or cochlear implants. The notable changes in this update are that PCV13 vaccination is now recommended in children aged 6 to 18 years at high risk for IPD, and that children in this group who have not previously been immunized with PPSV23 should receive a dose of PPSV23 =8 weeks following their dose of PCV13.

Commenting on the study in Journal Watch, Deborah Lehman, MD noted the dramatic decline in invasive pneumococcal disease, particularly meningitis, following introduction of conjugate vaccine. She added that further declines are expected now that this recommendation is expanded to include older children with high-risk conditions.

“Although immunologic response may be less predictable and duration of protection unknown in such patients, vaccine administration is safe, and these expanded recommendations may provide additional protection against invasive disease,” she wrote in her commentary. Dr. Reuben Ricallo w/Pediatrics and Journal Watch reports

Vital Signs Issue 71 Vol. 4, January 1-31 2015

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