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AAP, ACIP revise recommendation for PCV13 among children at high risk for IPD
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The CDC’s Advisory Committee on Immunization Practices and the AAP have updated recommendations for use of the 13-valent pneumococcal conjugate vaccine among children aged 6 to 18 years with an increased risk for invasive pneumococcal disease.
Unpublished data from the CDC indicate an average annual incidence of invasive pneumococcal disease (IPD) of 2.6 cases per 100,000 population among children aged 6 to 18 years from 2007 through 2009. Fifty-seven percent of IPD among this age group was caused by serotypes included in the PCV13 (Prevnar 13, Pfizer) vaccine.
Researchers found that 49% of IPD cases in immunocompromised children aged 6 to 18 years were caused by serotypes included in PCV13 while 23% of IPD cases were caused by serotypes in the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck).
Due to PCV13 serotypes, children aged 6 to 18 years with hematologic malignancies had an estimated incidence for IPD of 1,282 cases per 100,000 population. These children had a rate ratio of 822 (95% CI, 687-983) compared with children who did not have hematologic malignancies.
Children aged 6 to 18 years with HIV had an incidence for IPD due to PCV13 serotypes of 197 cases per 100,000 population (RR=122; 95% CI, 94-161).
Children with sickle cell disease had an incidence of 56 cases per 100,000 population (RR=27; 95% CI, 9-73).
The new recommendations for use of PCV13 among children aged 6 to 18 years with increased risk for IPD include:
- Children aged 6 to 18 years with immunocompromising conditions including HIV, functional or anatomic asplenia and sickle cell disease, cerebrospinal fluid leaks or cochlear implants who have not previously received PCV13 should receive a single dose of PCV13;
- PCV13 should be administered regardless of whether these children previously received PCV7 (Prevnar 7, Pfizer) or PPSV23;
- Children with immunocompromising conditions who have not previously received PPSV23 should receive a dose of PPSV23 at least 8 weeks after they receive PCV13;
- Children with high risk for IPD who have previously received PPSV23 should receive a single dose of PCV13 at least 8 weeks after the PPSV23 dose.
Recommendations for use of PPSV23 among children remain unchanged.
“Given the high burden of IPD caused by serotypes included in PPSV23 but not in PCV13, broader protection should be provided through use of both PCV13 and PPSV23,” the AAP’s Committee on Infectious Diseases said in a policy statement.
Disclosure: The researchers report no relevant financial disclosures.
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