Vaccine Recommendations (PCV13) for Children

When were the first conjugate vaccines licensed?
In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of Streptococcus pneumoniae and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten years later in February 2010, a new 13-valent product was licensed — PCV13 (Prevnar 13, Pfizer) — which added 6 new serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes account for the majority of invasive pneumococcal disease (IPD) in the U.S., including serotype 19A, which is the most common IPD-causing serotype in young children. In February 2010 ACIP recommended that healthcare providers transition from use of PCV7 to use of PCV13 for routine vaccination of children.

PCV7 was initially recommended for routine use in infants and children ages 2 through 59 months. The recommendations were expanded with the licensure of PCV13 to include vaccination of children age 60 through 71 months with underlying medical conditions, and also recommendations to consider vaccination of older children, ages 6 through 18 years, with medical conditions placing them at increased risk of invasive pneumococcal disease.

What are the recommendations for routine vaccination of children with PCV13?
All infants should be given a primary series of PCV13, at ages 2, 4, and 6 months with a booster at age 12 to 15 months. Children who fall behind should be given catch-up vaccination through age 59 months, if otherwise healthy or, through age 71 months if they have certain underlying medical conditions.
A healthy child received only one dose of PCV at age 10 months. She is now 6 years old. Our state requires one dose of PCV13 after the first birthday for school attendance. Her physician says because she is older than 59 months, she does not need another dose of PCV13. What should we do in this situation?
ACIP does not recommend routine PCV13 vaccination of healthy children 60 months of age or older. If there is a school requirement, the simplest solution is to give the child one dose of PCV13. However, health insurance may not pay for this dose. For more information on the ACIP recommendations for pneumococcal vaccination of children, go to www.cdc.gov/mmwr/pdf/rr/rr5911.pdf.
What are the recommendations for vaccinating children who previously received PCV7?
The table below can help guide the vaccination of infants and children who are in various stages of PCV vaccination (i.e., unvaccinated, begun a series of PCV7 or PCV13 but not yet completed, or have completed a series of PCV7).
Recommended Schedules for Administering Pneumococcal Conjugate Vaccine (PCV) to Children
By PCV Vaccination History and Age
Child’s age now Vaccination History of PCV7 and/or PCV13 Recommended PCV13 Schedule
(see footnote* below for minimum intervals between doses)
2 through 6 months 0 dose 3 doses, 8 weeks apart; 4th dose at age 12-15 months
1 dose 2 doses, 8 wks apart; 4th dose at age 12-15 months
2 doses 1 dose, at least 8 weeks after the most recent dose; dose #4 at age 12-15 months
7 through 11 months 0 doses 2 doses. 8 wks apart; dose #3 at age 12-15 months
1 or 2 doses before age 7 months 1 dose at age 7-11 months, with a second dose at age 12-15 months (8 wks later)
12 through 23 months 0 doses 2 doses, at least 8 weeks apart
1 dose before age 12 months 2 doses, at least 8 weeks apart
1 dose at or after age 12 months 1 dose, at least 8 weeks after the most recent dose
2 or 3 doses before age 12 months 1 dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate, complete PCV7 schedule 1 supplemental dose, at least 8 weeks after the most recent dose
24 through 59 months
(healthy)
Unvaccinated or any incomplete schedule 1 dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate, complete PCV7 schedule 1 dose, at least 8 weeks after the most recent dose
24 through 71 months
(with risk factor)
Unvaccinated or any incomplete schedule 2 doses, one at least 8 weeks after the most recent dose and another dose at least 8 weeks later
Any incomplete schedule of 3 doses 1 supplemental dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate complete PCV7 schedule 1 supplemental dose, at least 8 weeks after the most recent dose
* The minimum interval between doses of PCV7 or PCV13 administered at younger than 12 months of age is 4 weeks. The minimum interval for the next-to-last to last dose is 8 weeks.
Many children in my practice have received their complete series of PCV7. Would you please review the recommendations for which of them now need a supplemental dose of PCV13?
A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months who have received the complete 4-dose series of PCV7 or another age-appropriate, complete PCV7 schedule. For children who have underlying medical conditions, a single supplemental PCV13 dose is recommended through age 71 months. This also includes children who have previously received pneumococcal polysaccharide vaccine (PPSV23). Give the single supplemental dose of PCV13 no sooner than 8 weeks after the last dose of PCV7 or PPSV23 was given.

IAC has created a table that explains how to use PCV13 to catch up children who have fallen behind on their PCV7 doses. It is available at www.immunize.org/catg.d/p2016.pdf.

A 2-month-old was mistakenly given PPSV23 instead of PCV13. What should be done?
PPSV23 is not effective in children less than 24 months of age. PPSV23 given at this age should not be considered to be part of the pneumococcal vaccination series. PCV13 should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified.
There is a debate within my clinical department about not allowing influenza vaccine to be given with DTaP and PCV13. Are there data that state these should not be given concomitantly?
A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. Seewww.cdc.gov/vaccinesafety/concerns/febrile-seizures.html for more information.