Technically Speaking: Refresher! Use of Pneumococcal Vaccines in Infants, Children, and Children with Health Conditions

Since the licensure of PCV13 (Prevnar 13®, Pfizer) in 2010, the Advisory Committee on Immunization Practices (ACIP) has published three sets of recommendations for the use of PCV13 and PPSV23 (Pneumovax®23, Merck) in children. The guidance for high-risk conditions can be complex, but fortunately, a number of organizations have developed detailed materials to help healthcare professionals determine which of the two pneumococcal vaccines are recommended for whom and with what timing.

PCV13 vaccination of infants and young children

• All infants are recommended to receive a primary series of PCV13 at ages 2, 4, and 6 months, followed by a booster dose at age 12–15 months. Children who fall behind on the schedule should be given “catch-up” vaccinations through age 59 months.
• Children ages 60–71 months with certain health conditions who haven’t completed the four-dose series should complete it before their sixth birthday. These health conditions include (but are not limited to) sickle cell disease, anatomic or functional asplenia, HIV infection, and immunosuppression. For detailed guidance, see the ACIP recommendations for the use of PCV13 and PPSV23 in infants and children (12/10/10), as well as the ready-to-print resources section at the end of this article.

PCV13 vaccination for children 6 through 18 years

Children ages 6 through 18 years who have certain health conditions and are PCV13 naïve should receive a single dose of PCV13. These conditions include immunodeficiency, sickle cell disease, anatomic or functional asplenia, and CSF leaks, among others. For details, see ACIP recommendations for use of PCV13 and PPSV23 in children 6–18 years with immunocompromising conditions (6/28/13) and the resources section at the end.

PPSV23 vaccination for children age 2 through 18 years

Children age 2 years and older who have certain health conditions (in addition to needing PCV13) will also need to receive one or two doses of PPSV23 given at least five years apart. The number of PPSV23 doses needed depends on the child’s health condition. The PPSV23 dose #1 should be given at least eight (8) weeks after the PCV13 dose. Consult ACIP pneumococcal vaccine recommendations for children 6–18 years with risk conditions for details.

Ready-to-print materials on PCV13 and PPSV23

Immunization Action Coalition

• Recommendations for Pneumococcal Vaccines Use in Children and Teens
• Summary of Recommendations for Child/Teen Immunization
• Pneumococcal Vaccination Recommendations for Children and Adults by Age and/or Risk Factor
• Standing Orders for Administering Pneumococcal Conjugate Vaccine to Children

Centers for Disease Control and Prevention

Catch-Up Guidance for Healthy Children 4 Months through 4 Years of Age: Pneumococcal Conjugate Vaccine: PCV

California Department of Public Health

Pneumococcal Vaccine Timing — For Children

Additional tools

In addition, CDC has released a free mobile app, the PneumoRecs VaxAdvisor, to help vaccination providers quickly and easily determine which pneumococcal vaccines a patient needs and when.

IAC links to ACIP pneumococcal recommendations listed chronologically.