How are pediatric pneumococcal infections prevented?

Updated: Jan 14, 2019
  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

In March 2000, the US Food and Drug Administration approved a heptavalent protein-conjugate vaccine (PVC7) safe for use in children as young as 6 weeks. The new heptavalent conjugate vaccine has been recommended by the American Academy of Pediatrics Advisory Committee on Immunization Practices for all children younger than 2 years and for high-risk children (see Frequency) aged 2-5 years. The vaccine has been shown in several large-scale trials to markedly reduce the number of cases of meningitis and bacteremic pneumonia. The vaccine was less efficacious in reducing OM. Children should receive the pneumococcal vaccine at age 2, 4, 6, and 12-15 months.

Since the initiation of the heptavalent pneumococcal vaccine in 2000, researchers have found that nearly two thirds of invasive pneumococcal disease cases in young children have been caused by 6 serotypes not included in that vaccine. Those serotypes, along with the original 7, have been incorporated into the pneumococcal vaccine valent-13 (Prevnar 13), which was approved in February 2010. [12]

A recommendation from the American Association of Pediatrics states that children between the ages of 6 and 18 years with immune deficiency disorders and other high-risk conditions such as HIV, sickle-cell disease, or cerebrospinal fluid leaks should receive a single dose of PCV13. These children should receive the vaccination regardless of prior vaccination status. Also, if these children did not receive PPSV23 previously they should receive a dose of this vaccine no less than 8 weeks after their dose of PCV13. Recommendations for children aged 5 years and younger remain the same. [13]

A study by Moore et al assessed the effectiveness of PCV13 in 772 children aged 2-59 months and 2991 controls and found 86% effectiveness against PCV13 serotypes. The vaccine was most effective for serotypes 19A and 7F (85.6%). [14]

The older 23-valent pneumococcal polysaccharide vaccine is effective and safe in children older than 2 years. It can be used in children at high risk for invasive pneumococcal disease who have not received the conjugate vaccine. Children older than 24 months who are at high risk of pneumococcal infection should have received 4 doses of PCV7; recommendations suggest administration of Pneumovax (PPV23), which is a 23-valent vaccine, followed by another dose after 3-5 years to give additional protection. Further study is required to determine whether revaccination is necessary in later years and which vaccine should be administered if revaccination is necessary.

Pneumococcal vaccination with PCV7 and/or PPV 23 is recommended 2 weeks prior to splenectomy, cochlear implant, or immunosuppressive therapy. Children who are diagnosed with invasive pneumococcal disease should still complete their pneumococcal vaccine series.

Although the World Health Organization (WHO) recommends global implementation of PCV7, only a few countries have introduced PCV7 because of difficulty with completion of the 3 + 1 dose schedule (ie, doses at 2 mo, 4 mo, 6 mo, and 12-15 mo).

van Gils et al conducted a study to examine reduced pneumococcal carriage with vaccination schedules of 2 doses (administered at age 2 mo and 4 mo) or 2 + 1 dose (administered at age 2 mo, 4 mo, and 11 mo). [15] Vaccine serotype pneumococcal carriage rates were measured during the second year of life. Vaccine serotype pneumococcal carriage was significantly decreased after both PCV7 schedules at age 12 months; 25% in the 2-dose schedule and 20% in the 2 + 1-dose schedule, compared with 38% in the control group who did not receive the vaccine (both P < 0.001).

At 18 months, the 2 + 1–dose schedule group had further decreased to 16% and, at 24 months, decreased to 14% (both P < 0.001).

The 2-dose schedule group remained stable at 18 months (24%), but at 24 months had further decreased to 15% (both P < 0.001).

In the control group, vaccine serotype pneumococcal carriage remained around 36-38% until 24 months.

Results showed that significant reductions of vaccine serotype pneumococcal carriage occurred in the second year of life for those on the 2 + 1–dose or 2-dose schedule for PCV7 vaccination compared with those who did not receive pneumococcal vaccination.

The results of one study of 300 infants noted that newborn immunization with pneumococcal conjugate vaccines was safe and immunogenic, priming the patient for immunological memory, with no evidence of immune tolerance. While not an official recommendation, these preliminary results suggest that vaccination beginning at birth may offer an alternative to infants at high risk of invasive pneumococcal disease (IPD), such as those in developing countries. [16]

Further recommendations for prevention include restricting antibiotic use to reduce the resistance, adding more antigen to the pneumococcal vaccine, and improving the vaccination coverage.


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