Older High-Risk Children Should Receive PCV13, AAP Says

Children between the ages of 6 and 18 years with immune deficiency disorders and other high-risk conditions should receive a single dose of PCV13, according to a new recommendation from the American Association of Pediatrics (AAP) published in the December issue of Pediatrics.

The AAP recommends that children in this age group with HIV, sickle-cell disease, cerebrospinal fluid leaks, or cochlear implants receive the pneumococcal conjugate vaccine PCV13 if they have not previously received it. They should receive this dose of PCV13 regardless of whether they have received PCV7 or PPSV23 in the past.

In addition, if these children have not previously been vaccinated with the pneumococcal polysaccharide vaccine PPSV23, they should receive a dose of this vaccine no less than 8 weeks after their dose of PCV13.

AAP continues to recommend that children with HIV, sickle cell disease, and other immune deficiency disorders receive a second dose of PPSV23 at 5 years after the first dose.

Previously, the AAP only recommended PCV13 for all children aged 5 years and younger. Recommendations for that group remain the same.

The introduction of pneumococcal conjugate vaccines, beginning in 2000, has dramatically reduced the rate of invasive pneumococcal disease (IPD) in children overall, the policy statement notes. However, older children with immunodeficiency and the other conditions mentioned have much higher rates of IPD, necessitating the new recommendations.

From 2007 to 2009, the incidence of IPD in all children aged 6 to 18 years was 2.6 cases per 100,000 population. In children aged 6 to 18 years with immune deficiencies, the incidence was much higher, at 197 per 100,000 for children with HIV and 56 per 100,000 for those with sickle cell disease. Nearly half (49%) of the IPD cases among immunocompromised children were caused by serotypes included in PCV13, and an additional 23% were caused by serotypes included in PPSV23.

The AAP's recommendations follow a similar recommendation from the Advisory Committee on Immunization Practices in June 2013. Also in 2013, the US Food and Drug Administration approved the use of PCV13 in healthy children aged 6 years and older.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2014;134:1230-1233.

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