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Prevention

Vaccine

The best way to prevent pneumococcal disease is to vaccinate your patients.

The pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) provides protection against the 13 serotypes responsible for most severe illness. The vaccine can also help prevent some ear infections. CDC recommends administering PCV13 as a four-dose series at 2, 4, 6, and 12 through 15 months of life. Research shows that this vaccine is very effective at preventing infection resulting from the serotypes contained in the vaccine. PCV13 should also be administered to all adults 65 years or older and to some adults 19 through 64 years of age with conditions that put them at increased risk for pneumococcal disease.

The pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23®) is a 23-valent polysaccharide vaccine that CDC recommends for use in all adults who are 65 years or older and for persons who are 2 years or older and at increased risk for disease. CDC also recommends this vaccine for use in adults 19 through 64 years of age with conditions that put them at increased risk for pneumococcal disease.

Yearly influenza vaccination is also very important because the flu increases your patient’s chances of getting pneumococcal disease.

For more information on who should get a pneumococcal vaccine, see the ACIP recommendations.

Before routine use of pneumococcal conjugate vaccine, the burden of pneumococcal disease among children younger than 5 years old was significant.

  • An estimated 17,000 cases of invasive disease occurred each year, of which 13,000 were bacteremia without a known site of infection and about 700 were meningitis.
  • An estimated 200 children died every year as a result of invasive pneumococcal disease.
  • Although not considered invasive disease, an estimated 5 million cases of acute otitis media occurred each year among children younger than 5 years old.

Chemoprophylaxis

The American Academy of Pediatrics typically recommends daily antimicrobial prophylaxis with oral penicillin V or G for children with functional or anatomic asplenia, especially those with sickle-cell disease. In general, you should consider antimicrobial prophylaxis (in addition to immunization) for all children with asplenia younger than 5 years of age and for at least 1 year after splenectomy.

Because secondary cases of invasive pneumococcal infection are uncommon, chemoprophylaxis is not indicated for contacts of patients with such infection.

References

American Academy of Pediatrics. Antimicrobial therapy for treatment and prophylaxis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed. Elk Grove Village, IL; 2015:72.

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