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a child has been diagnosed with pneumococcal disease are they
They are only immune to that serotype of pneumococcus. There
are at least 90 serotypes of Streptococcus pneumoniae.
The child should still be vaccinated as age-appropriate to protect
against the other serotypes in the vaccine. (2/20/03)
children over 24 months of age, which pneumococcal vaccine is
If the child between 24 and 59 months of age is at high risk
for pneumococcal disease, then both PCV & PPV are indicated.
If the child is not at high risk, then only PCV is indicated.
(PCV) Recommendations (see pages 21-27) (2/20/03)
clarify the recommended and minimum intervals between doses
of PCV vaccine?
The recommended interval between the first 3 doses given under
12 months of age is 8 weeks. The minimum interval is 4 weeks.
The minimum age for the 4th dose is 12 months of age and there
must be at least 8 weeks between the 3rd and 4th doses. ACIP
General Recommendations (see page 3) (2/20/03)
have a clinic-based influenza vaccine program and we get a lot
of inquiries about the pneumococcal vaccine. The question is
do you recommend the pneumococcal vaccine only in a physician-based
program? We are concerned that patients don't have their record
and aren't sure when or if they have received the vaccine?
If your state and agency allow you to provide vaccines under
a standing order protocol, then both influenza and pneumococcal
vaccines can be administered when recommended, www.cdc.gov/mmwr/PDF/rr/rr4901.pdf.
The ACIP states in their recommendations for pneumococcal polysaccharide
vaccine that elderly persons with unknown vaccination status
should be administered one dose of vaccine, ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4608.pdf
(See Figure 1 and page 15). (6/26/03)
the pneumococcal polysaccharide vaccine protect against Mycoplasma
No. Pneumococcal vaccines protect only against certain serotypes
of Streptococcus pneumoniae. (6/26/03)
there any situation in which you should give PCV to an adult?
No, pneumococcal conjugate vaccine is only licensed by FDA for
children up to 9 years of age and recommended by ACIP for children
up to 5 years of age, http://www.fda.gov/cber/label/pneuled021700LB.pdf
is it appropriate to give both PCV7 and PPV23 vaccines?
A child who has received pneumococcal conjugate vaccine AND
who has a high-risk condition for which PPV23 is recommended,
should receive PPV23 vaccine as long as they are at least 2
years of age and it has been at least 2 months since the last
dose of PCV7. PPV23 offers protection against additional pneumococcal
serotypes, but children less than 2 years of age do not respond
well to polysaccharide vaccines, http://www.cdc.gov/mmwr/PDF/rr/rr4909.pdf
(see page 27). (8/21/03)
can’t you administer PCV and PPV23 simultaneously?
We do not have data on what happens when you give them simultaneously,
for example severity of local reactions. ACIP recommends the
conservative approach, to always separate pneumococcal conjugate
and pneumococcal polysaccharide vaccines by two months. (8/21/03)
you give a 3 year old child who attends day care PCV or PPV,
ACIP includes day care attendance as a high-risk factor for
pneumococcal conjugate vaccine (PCV). Out-of-home day care increases
the risk for invasive pneumococcal disease and
AOM among children. In a study of risk factors for invasive
pneumococcal disease among children in the United States, attendance
at a group day care center during the preceding 3 months was
associated with an approximately 2.3-fold increase in invasive
disease among children aged 12–23 months, and 3.2-fold
increased risk among children aged 24–59 months. Moreover,
in a recent population-based case-control study, nonelderly
adults (i.e., persons aged 18–64 years) who lived in a
household that included children who attended day care were
at greater risk for acquiring invasive pneumococcal infections
than adults who did not (multivariate odds ratio [OR] = 3.0).
studies of otitis media resulting from all causes, risk for
AOM was higher among children who attended day care outside
the home compared with family day care, and risk for middle
ear effusions increased with exposure to larger numbers of children
in day care settings. Younger age when starting day care also
increases risk for experiencing recurrent AOM. Day care attendance
is also a risk factor for other acute upper respiratory tract
infections among children aged <5 years. ACIP
Pneumococcal (PCV) Recommendations (see page 6) (2/20/03)
Prevnar package insert seems to suggest the vaccine can be used
up to 9 years of age. What does ACIP recommend? Is there any
advantage to giving the vaccine to older children with chronic
Data are limited regarding efficacy of PCV7 among children 5
and older, and adults. However, limited studies report that
a) a 5-valent pneumococcal conjugate vaccine was immunogenic
among HIV-infected children aged 2–9 years; b) PCV7 is
among children aged 2–13 years with recurrent respiratory
infections ; and c) PCV7 is immunogenic among older children
and adults aged 4–30 years with SCD. Administering PCV7
to older children with high-risk conditions is not contraindicated.
(PCV) Recommendations (see page 26) (2/20/03)
pneumococcal vaccine be given to someone with asthma?
"Asthma has not been associated with an increased risk
for pneumococcal disease unless it occurs with chronic bronchitis,
emphysema, or long-term use of systemic corticosteroids."
This is from page 3 of the ACIP PPV23 recommendations. Asthma
alone is also not an indication for PCV. ACIP
Pneumococcal (PPV) Recommendations (see page 3) and ACIP
Pneumococcal (PCV) Recommendations (see page 22) (2/20/03)
a history of pneumonia a high risk factor for pneumococcal vaccine?
Pneumococcal vaccine is indicated for persons with chronic lung
disease (e.g., COPD and emphysema). Pneumonia without a history
of chronic lung disease is not an indication for pneumococcal
Pneumococcal (PPV) Recommendations and ACIP
Pneumococcal (PCV) Recommendations (2/20/03)
vaccines are indicated for someone with a splenectomy and is
there concern that a person with a splenectomy may have a less
than optimum response to vaccines?
Persons who do not have a functioning spleen or who have had
a splenectomy do not handle encapsulated bacteria well and,
therefore, are at increased risk for infection with encapsulated
bacteria, especially Neisseria meningitidis and Streptococcus
pneumoniae. They should be vaccinated with age-appropriate
pneumococcal vaccine and meningococcal vaccine.
Persons two years of age and older should receive two doses
of pneumococcal polysaccharide vaccine separated by 3-5 years,
depending on the age at time of revaccination. One dose of meningococcal
vaccine should be administered. The recommendation for a booster
dose is somewhat vague because polysaccharides aren’t
the best antigens and don’t boost antibody titers very
much with subsequent doses. However, high-risk people, including
those without a functioning spleen can receive a one-time revaccination
3-5 years after the first dose. Certainly no more than a total
of two doses should be given. Some providers also choose to
administer one pediatric dose of Haemophilus influenzae
type b vaccine, regardless of age. Ideally the Hib dose should
be given a couple of weeks prior to a scheduled splenectomy.
Immunosuppression is not an issue unless the patient has other
health issues or treatments that are suppressing the immune
system. Their response to vaccination should not be affected
by the lack of a functioning spleen, ACIP
Adult Recommendations (See “ Splenic Dysfunction or
Anatomic Asplenia”) and ACIP
Altered Immunocompetence Recommendations (see page 2). (2/13/03)
a person who has received a stapes prothesis be vaccinated with
the age-appropriate pneumococcal vaccine?
There are no ACIP recommendations regarding pneumococcal vaccination
of persons with a stapes prothesis. (8/21/03)
an adult who has had a cochlear implant be vaccinated with meningococcal
or pneumococcal vaccine?
The recommendation is to include people who have had a cochlear
implant in the high risk group for pneumococcal disease. If
the person is under 2 years of age, give pneumococcal conjugate
vaccine. If the person is between 2 and 5 years of age, give
two doses of pneumococcal conjugate vaccine and one dose of
pneumococcal polysaccharide vaccine, separating the doses by
a two months each. Persons 5 years of age and older should get
a single dose of pneumococcal polysaccharide vaccine.
The cases of meningitis reported to date have been mostly pneumococcal.
There have only been one or two cases caused by Neisseria
meningitidis and none caused by Haemophilus influenzae.
There are no recommendations at this time to vaccinate these
individuals with meningococcal vaccine. NIP
Cochlear Implant Webpage (2/20/03)
you complete the pneumococcal vaccination series prior to a
scheduled cochlear implant if possible?
Yes, if you can. You can accelerate the schedule since the child
will become high risk after the implant. You want to get in
as many doses as possible, then complete the series after the
implant if necessary. The child will probably need a booster
after a year anyway. A child less than 2 years of age should
receive only pneumococcal conjugate vaccine. A child 2 to 5
years of age should receive both pneumococcal conjugate and
pneumococcal polysaccharide vaccines. A person 5 years of age
or older should receive the pneumococcal polysaccharide vaccine.
Cochlear Implant Webpage (2/20/03)
an adult with a cochlear implant receives a dose of PPV, when
should they receive the second dose?
Persons aged 5 to 64 years with a cochlear implant should receive
a single dose of pneumococcal polysaccharide vaccine. These
persons should receive a second dose of pneumococcal polysaccharide
vaccine at age 65 years, if at least 5 years have elapsed since
their last dose. People with cochlear implants should be treated
like other people with underlying illness like cardiac or renal
disease. They are not in the highest risk group like persons
with asplenia or other immunocompromising conditions for whom
a second dose is recommended 5 years after the first dose, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a5.htm
a child less than 24 months of age with a cochlear implant receives
the recommended doses of PCV, will the child need a dose of
PPV23 at 24 months of age?
Yes, these children should also receive one dose of pneumococcal
polysaccharide vaccine, at least 2 months after the last dose
of pneumococcal conjugate vaccine, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a5.htm.
PPV - In the hospital setting, a number of physicians are questioning
the safety of administration of PPV to patients who have pneumonia.
What literature can you recommend to demonstrate the safety
of administration of PPV to these patients? Also, a number of
physicians are questioning the safety of administration of PPV
to patients who have pneumonia. What literature can you recommend
to demonstrate the safety of administration of PPV to these
you tell us the specific contraindications to this vaccine?
These issues are discussed in an article by David Fedson in
Infection Control and Hospital Epidemiology:
"Hospital-based influenza and pneumococcal vaccination:
Sutton's Law applied to prevention." Fedson DS, Houck P,
Bratzler D. Infect Control Hosp Epidemiol. 2000 Nov;21(11):692-9.
There is no published evidence that vaccination of hospitalized
people at discharge is any more or less safe than vaccination
in any other circumstance. The vaccine components are inactivated
and CANNOT cause disease. Hospitalized patients for whom PPV23
is recommended should be vaccinated at discharge. Failing to
do so is missing an important opportunity to protect these patients
against pneumococcal disease.
of anyone with an acute disease should be delayed until the
acute symptoms abate, however, this does not mean that the illness
must be completely resolved.
Following are the contraindications and precautions:
serious allergic reaction to a dose of pneumococcal vaccine
or a vaccine component is a contraindication to further doses
of vaccine. Such allergic reactions are rare.
Persons with moderate or severe acute illness should not be
vaccinated until their condition improves. However, minor
illnesses, such as upper respiratory infections, are not a
contraindication to vaccination.
The safety of PPV23 vaccine for pregnant women has not been
studied, although no adverse consequences have been reported
among newborns whose mothers were inadvertently vaccinated
during pregnancy. Women who are at high risk of pneumococcal
disease and who are candidates for pneumococcal vaccine should
be vaccinated before pregnancy, if possible.
You will find further information about PPV23 in the ACIP
isn’t there a recommendation to give pneumococcal polysaccharide
vaccine (PPV23) boosters to high-risk individuals every 5 years?
Is it because of severe local reactions?
Ongoing booster doses are not recommended because pneumococcal
polysaccharide vaccine does not boost well. Current data do
not indicate that administering multiple boosters of PPV23 provides
any more protection than one dose followed by a one-time booster
5 years later. (6/26/03)
person who get their first dose of pneumococcal polysaccharide
vaccine at 65 years of age need a booster dose later on?
depends. Healthy persons who get their first dose just because
they hit that magic mark of 65 years old don’t automatically
need a booster dose 5 years later. Only those who have or later
develop a high-risk condition for which revaccination is recommended,
should receive a booster dose after 5 years or more. (6/26/03)
clarify the recommendations for revaccination with PPV23?
The following fact sheet provides an excellent summary of the
ACIP recommendations for PPV23 revaccination, http://www.immunize.org/catg.d/2015pne.pdf.