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Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in Children Aged 24--59 Months Who Are Not Completely Vaccinated

This notice updates the recommendation for use of 7-valent pneumococcal conjugate vaccine (PCV7) among children aged 24--59 months who are either unvaccinated or who have a lapse in PCV7 administration.* In February 2000, PCV7, marketed as Prevnar® and manufactured by Wyeth Vaccines (Collegeville, Pennsylvania), was approved by the Food and Drug Administration for use in infants and young children. At that time, the Advisory Committee on Immunization Practices (ACIP) recommended that children aged 24--59 months who have certain underlying medical conditions or are immunocompromised receive PCV7. In addition, ACIP recommended that PCV7 be considered for all other children aged 24--59 months, with priority given to those who are American Indian/Alaska Native or of African-American descent, and to children who attend group day care centers (1). The recommendation also provided schedules for administering PCV7 to children aged 24--59 months who were either unvaccinated or who had a lapse in PCV7 administration; these schedules included 1) 1 dose of PCV7 for healthy children, and 2) 2 doses of PCV7 >2 months apart for children with certain chronic diseases or immunosuppressive conditions (1).

ACIP's rationale for limiting the recommendation for routine vaccination to children aged 24--59 months who have certain underlying medical conditions or are immunocompromised was concern about limited vaccine supply and cost. Since September 2004, PCV7 has not been in short supply (2). Additionally, certain health-care providers have found the permissive recommendation for healthy children aged 24--59 months to be confusing. The ACIP Pneumococcal Vaccines Work Group reviewed data on safety and immunogenicity of PCV7 in children aged 24--59 months, current rates of PCV7-type invasive disease, vaccination coverage rates, and post-licensure vaccine effectiveness. In October 2007, on the basis of that review, ACIP approved the following revised recommendation for use of PCV7 in children aged 24--59 months:

  • For all healthy children aged 24--59 months who have not completed any recommended schedule for PCV7, administer 1 dose of PCV7.
  • For all children with underlying medical conditions aged 24--59 months who have received 3 doses, administer 1 dose of PCV7.
  • For all children with underlying medical conditions aged 24--59 months who have received <3 doses, administer 2 doses of PCV7 at least 8 weeks apart.

No changes were made to previously published recommendations regarding 1) the use of PCV7 in children aged 2--23 months, 2) the list of underlying medical or immunocompromising conditions, or 3) the use of 23-valent pneumococcal polysaccharide vaccine in children aged >2 years who have previously received PCV7 (3).

References

  1. CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(No. RR-9).
  2. CDC. Pneumococcal conjugate vaccine shortage resolved. MMWR 2004;53:851--2.
  3. CDC. Recommended immunization schedules for persons aged 0--18 years---United States, 2008. MMWR 2008;57(1):Q1--4.

* PCV7 is recommended for routine administration as a 4-dose series for infants at ages 2, 4, 6, and 12--15 months. Catch-up immunization is recommended for children aged <23 months, using fewer doses depending on age at the time of first vaccination.

The minimum interval between all doses of PCV7 for children aged 24--59 months is 8 weeks.

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Date last reviewed: 4/2/2008

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