From the office of the Medical Health Officer
One Less Injection of Pnymococcal Conjugate Vaccine for Your Healthy Infant Patients!
In January 2007, as a result of new information on the immunogenicity and effectiveness of pneumococcal conjugate vaccine (Prevnar) for infants, the province of British Columbia announced that
healthy infants will now receive three doses of Prevnar at 2, 4, and 12 months old
(instead of the previous four doses at 2, 4, 6, and 18 months of age)
To monitor for possible effects of this schedule change, we will be doing enhanced surveillance on ALL invasive pneumococcal disease cases.
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Fraser Health is starting the three-dose schedule on March 1, 2007.
Healthy children already begun on Prevnar will move tot he new schedule as follows:
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Prevnar already given at
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Dose of Prevnar to be given
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2 months old
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One dose at 12 months old
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2 and 4 months old
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One dose at 12 months old
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2, 4 and 6 months old
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One dose at 12 months old (if too late for 12 months, give at 18 months old)
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Infants at high risk of invasive pneumococcal disease will continue to receive four doses of Prevnar (but at 2, 4, 6 and 12 months of age) PLUS one dose of pneumococcal polysaccharide vaccine at ?24 months of age
High-risk conditions for invasive pneumococcal disease
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anatomic or functional asplenia
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sickle cell disease;
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immunosuppression related to disease ( e.g., HIV, lymphoma, Hodgkin’s, multiple myeloma) or therapy (e.g., high dose systemic steroids);
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chronic heart or lung disease, including but not limited to, congenital heart defects and cyanotic heart disease, congestive heart failure, pulmonary anomalies, bronchopulmonary dysplasia, COPD, chronic bronchitis (adults), emphysema, and cystic fibrosis.
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chronic liver disease including cirrhosis, chronic hepatitis B, chronic hepatitis C;
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chronic renal disease;
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diabetes;
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cystic fibrosis;
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chronic CSF leak;
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receipt of islet cell or solid organ transplant, or hematopoietic stem cell transplant (HSCT); a cochlear implant, or those who will be receiving a cochlear implant.
Aboriginal children are not considered high risk unless they have one of the conditions listed above.
PNEUMOCOCCAL VACCINATION FOR CHILDREN (HEALTHY & HIGH-RISK)
Please phone your Health Unit for scheduling advice if:
- a previously healthy child who finished the Prevnar series then develops a high-risk condition, or
- you see a child who started vaccination with Prevnar but whose schedule was interrupted.
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HEALTHY CHILD
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Age
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Dose
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Comments
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| 2 months
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Dose #1 Prevnar
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| 4 months
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Dose #2 Prevnar
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Give at least 8 weeks from dose #1 EXCEPT when child is behind, in which case give a minimum of 28 days after dose #1
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| 12 month
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Dose #3 Prevnar
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Prevnar booster dose. Give at least 8 weeks after dose #2.
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DELAYED START
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A healthy child starting at 12-23 months old
needs only 2 doses of Prevnar 8 weeks apart.
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A health child starting at 24-59 months old
needs only 1 dose of Prevnar.
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HIGH-RISK CHILD
(see list of high risk conditions above)
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Age
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Dose
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Comments
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| 2 months
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Dose #1 Prevnar
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| 4 months
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Dose #2 Prevnar
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Give at least 8 weeks from dose #1 EXCEPT when child is behind, in which case give a minimum of 28 days after dose #1
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| 6 months
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Dose #3 Prevnar
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Give at least 8 weeks from dose #1 EXCEPT when child is behind, in which case give a minimum of 28 days after dose #1
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| 12 months
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Dose#4 Prevnar
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Prevnar booster dose. Give at least 8 weeks after dose #3
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| 2 years
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Pneumococcal polysaccharide booster
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Give at least 8 weeks after3rd dose of Prevnar, to boost protection provided by Prevnar (conjugate) series.
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DELAYED START
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A high-risk child starting at 1-
<5 years old
needs two Prevnar doses 8 weeks apart, PLUS a polysaccharide booster ? 2 years old, given 8 weeks after the 2nd dose of Prevnar.
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An asplenic child starting at 5-16 years old
needs two Prevnar doses 8 weeks apart, PLUS a polysaccharide booster given 8 weeks after the 2nd dose of Prevnar.
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References
BCCDC.
Why BC is moving from four to three doses of conjugate pneumococcal vaccine for infant immunization
BCMJ 48(10) Dec 06:498-9 This article gives the detailed rationale for moving to a three dose schedule.
Whitney C et al. Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet 368; 28 Oct 06. “Effectiveness of one or more doses against vaccine serotypes was 96% (95% CI 93-98) in healthy children and 81% (57-92) in those with coexisting disorders.”
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