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| General information - pneumococcal conjugate |
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| What
are the ACIP recommendations for use of pneumococcal conjugate
vaccine routinely in children? |
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| ACIP recommends that all children receive 4 doses of PCV at
ages 2, 4, 6, and 12-15 months of age. |
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| What is the catch-up schedule
for children who have fallen behind on their PCV doses? |
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| The ACIP recommendations (MMWR 2000;
49 [RR-9]) or www.cdc.gov/mmwr/pdf/rr/rr4909.pdf contain
a table that will help guide vaccination decisions for children with
lapsed schedules. The
table is reproduced below. |
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| Recommendations for use of 7-valent
pneumococcal conjugate vaccine (PCV7) among children with a lapse
in vaccine administration* |
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| Age
at exam (mos) |
Previous PCV7 vaccination
history |
Recommended
regimen |
| 7–11 |
1 or 2
doses |
1 dose of
PCV7 at 7–11 mos, and a dose >2 mos later, at 12–15
mos |
| 12–23 |
1 dose before age 12 mos |
2 doses
of PCV7 >2 mos apart |
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2 doses before age 12 mos |
1 dose of
PCV7 >2 mos after most recent dose |
| 24–59 |
Any incomplete schedule |
1 dose
(For
children with health conditions, see Q&A that follows) |
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*
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Source:
Table 11 from CDC's "Preventing Pneumococcal Disease Among
Infants and Young Children," MMWR 2000; 49 (RR-9):
p.24. |
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| How many doses of PCV vaccine should
be given to unvaccinated children age 2 years and older? |
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| Healthy unvaccinated children ages 24
through 59 months should receive 1 dose of PCV. Children with certain
chronic diseases or immunosuppressing conditions (e.g., sickle cell
disease; anatomic/functional asplenia; chronic cardiac, pulmonary, or
renal disease; diabetes; cerebrospinal fluid leaks; HIV infection;
immunosuppression; or who have or will have a cochlear implant) should
receive 1 dose if they previously received 3 doses or 2 doses separated
by 8 weeks if they previously received fewer than 3 doses. |
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| Can PCV be used in children
older than age 5 years? |
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| Neither ACIP nor AAP routinely recommend PCV for children 5
years of age or older. However, the vaccine is licensed for use through
age 9 years. Some providers may choose to administer PCV to older children
who are at highest risk of invasive pneumococcal disease, such as those
with HIV infection or anatomic or functional asplenia. The use of PCV
in children ages 5 through
9 years of age is not contraindicated. |
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| An 18-month-old received dose
#1 of PCV seven days before her first birthday and dose #2 at age
15 months. Does she need a third dose? |
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| A schedule for "lapsed" vaccination can be found in the PCV
ACIP statement (MMWR, Oct. 6, 2000; vol. 49, no. RR-9). According to
this schedule, a child 12-23 months of age who received one dose of PCV
before the first birthday should receive two additional doses after the
first
birthday. This child needs one more dose now to complete the series. |
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| Do children who are diagnosed
with pneumococcal disease still need to receive pneumococcal
conjugate vaccine? |
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| Yes. There are several different serotypes of Streptococcus
pneumoniae that cause disease in children. A child who has had pneumococcal
disease has only developed antibody against one
serotype. |
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| When is it appropriate to give both pneumococcal conjugate vaccine (PCV7) and pneumococcal polysaccharide vaccine (PPSV)? |
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| A child who has received pneumococcal conjugate vaccine AND who has a high-risk condition for which PPSV is recommended, should receive PPSV vaccine as long as they are at least 2 years old and it has been at least 2 months since their last dose of PCV7. |
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| If a physician administers PCV
and PPV (pneumococcal polysachharide vaccine) to a high-risk child
age 2 years or older, at what intervals should the two vaccines
be
administered? |
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| ACIP recommends that PCV and PPV be
separated by at least 8 weeks. Give PCV first and then wait 8 weeks
before giving PPV. For more information, see the ACIP statement
on PCV at
www.cdc.gov/mmwr/PDF/rr/rr4909.pdf (p.
26-7). |
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| A 2-month-old was mistakenly
given PPV instead of PCV. What should be done? |
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| PPV is not effective in children less than 24 months of age.
PPV given at this age should not be considered to be part of the pneumococcal
vaccination series. PCV should be administered as soon as the error is
discovered. Children 5 years and older will generally receive only PPV.
Doses of PCV and PPV given at age 2-5 years should be separated by an
interval of at least 8 weeks. Anytime the wrong vaccine is given, the
parent/patient should be notified. |
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When should a child undergoing splenectomy receive pneumococcal
vaccine(s)? |
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| It is preferable that the child have
antibody to pneumococcus at the time of the procedure, so administer the
appropriate vaccine prior to splenectomy if possible. Children 2 through
59 months of age should receive one or more doses of PCV if not up to
date already for this vaccination. Children 2 years of age and older
should receive PPV regardless of whether they also received PCV. |
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| Reviewed on 10/09 |
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