How is pneumococcal infection prevented in high-risk patients?

Updated: Aug 27, 2018
  • Author: Claudia Antonieta Nieves Prado, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

High-risk patients include those with sickle cell disease or hemoglobinopathies, asplenia (congenital or functional), HIV infection, cochlear implants, those of Alaskan Native descent (and of some American Indian populations) who are younger than 2 years, immunocompromising conditions (congenital immune deficiencies), chronic cardiac or pulmonary illness, diabetes mellitus, chronic renal insufficiency (including nephrotic syndrome), diseases requiring immunosuppressive or radiation therapy, and/or CSF leaks. [7]

Table 4. Recommended Schedule for Doses of PCV13, Including Catch-up Immunizations in Previously Unimmunized and Partially Immunized Children [7] (Open Table in a new window)

Age at Examination (mo)

Immunization History

Recommended Regimen*

2-6

0 doses

3 doses, 2 mo apart; fourth dose at age 12-15 mo

 

1 dose

2 doses, 2 mo apart; fourth dose at age 12-15 mo

 

2 doses

1 dose, 2 mo after the most recent dose; fourth dose at age 12-15 mo

7-11

0 doses

2 doses, 2 mo apart; third dose at age 12 mo

 

1 or 2 doses before age 7 mo

1 dose at age 7-11 mo, with another dose at age 12-15 mo (≥2 mo later)

12-23

0 doses

2 doses, ≥2 mo apart

 

1 dose at < 12 mo

2 doses, ≥2 mo apart

 

1 dose at ≥12 mo

1 dose, ≥2 mo after the most recent dose

 

2 or 3 doses at < 12 mo

1 dose, ≥2 mo after the most recent dose

24-71 [75]

 

 

Healthy children

(24-59mo)

Any incomplete schedule

1 dose, ≥2 mo after the most recent dose†

Children at high

risk‡ (24-71 mo)

Any incomplete schedule of < 3 doses

2 doses, one ≥2 mo after the most recent dose and another dose ≥2 mo later

 

Any incomplete schedule of 3 doses

1 dose, ≥2 mo after the most recent dose

*In children immunized before age 12 mo, the minimum interval between doses is 4 weeks. Doses administered at age 12 months or later should be administered at least 8 weeks apart.

† Providers should administer a single dose to all healthy children aged 24-59 mo with any incomplete schedule.

‡Children with sickle cell disease, asplenia, chronic heart or lung disease, diabetes mellitus, CSF leak, cochlear implant, HIV infection, or another immunocompromising condition. PPV23 is also indicated (see below).

Many clinical investigations have shown the positive impact of the pneumococcal conjugate vaccine on invasive and noninvasive disease in children, as well as the reduction in nasopharyngeal carriage of vaccine serotypes. [85, 86]

The increasing vaccination rates in children and resultant herd immunity coupled with the increased number of serotypes, even with a possible inferior immune response of the polysaccharide vaccine, make this question relevant.


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