New recommendations for pneumococcal vaccine

The Advisory Committee on Immunization Practices (ACIP) has updated its recommendations regarding the use of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) in children aged 6 to 18 years with immunocompromising conditions.

The committee now recommends routine use of PCV13 for children aged 6 to 18 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants who have not previously received the vaccine, regardless of whether they received the 7-valent pneumococcal conjugate vaccine (PCV7) or PPSV23.

This reflects a policy change from permissive and off-label use of PCV13 in this pediatric immunocompromised population to a category A recommendation.

Licensed by the US Food and Drug Administration in February 2010 when it replaced PCV7, PCV13 has been recommended for all children aged younger than 5 years and for children aged 60 to 71 months with chronic medical conditions, immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants. This new recommendation now extends the age range for use in the latter.

Recommendations for use of PPSV23 for this age group remain unchanged. Essentially, PPSV23 is recommended for children aged 2 years and older with increased risk of invasive pneumococcal disease (IPD). Because PPSV23 covers 11 serotypes that PCV13 doesn’t, children aged 6 to 18 years who have not received PCV13 and are at increased risk for IPD should receive a single PCV13 dose, followed by a dose of PPSV23 at least 8 weeks later, followed by a second PPSV23 dose 5 years after the first PPSV23 dose.

Furthermore, children aged 6 to 18 years who have not received PCV13, are at increased risk for IPD, and who previously received at least 1 dose of PPSV23 should receive a single PCV13 dose at least 8 weeks after the last PPSV23 dose, even if they have received PCV7. If a second PPSV23 dose is indicated, it should be given 5 or more years after the first PPSV23 dose. No one should receive more than 2 doses of PPSV23 before aged 65 years.

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