High-Risk Children Need PCV13 Pneumococcal Conjugate Vaccine, AAP Says

By Reuters Staff

NEW YORK - Children at the highest risk of invasive pneumococcal disease should be immunized with the PCV13 pneumococcal conjugate vaccine, even if they have already received PCV7 and/or PPSV23, according to American Academy of Pediatrics (AAP)'s Committee on Infectious Diseases.

PCV13 is already recommended for all children two through 59 months old and for children 60 through 71 months old with chronic medical conditions, immunocompromising conditions, cerebrospinal fluid (CSF) leaks, or cochlear implants. For children six through 18 years with these same high-risk conditions, PPSV23 has been routinely recommended.

In light of ongoing invasive pneumococcal disease caused by vaccine serotypes in older children with immunodeficiency and other high-risk conditions, Dr. Carrie L. Byington and colleagues on the AAP committee reviewed the evidence and considered modifications to their earlier recommendations.

PPSV23 contains 12 of the 13 serotypes included in PCV13, and combined, the 23 serotypes account for 23% of invasive pneumococcal disease (IPD) cases among immunocompromised children six through 18 years of age.

"Given the high burden of IPD caused by serotypes included in PPSV23 but not in PCV13, broader protection should be provided through use of both PCV13 and PPSV23," according to the November 24 policy statement in Pediatrics.

Accordingly, the statement recommends for the first time that a single dose of PCV13 be given to children six through 18 years of age who have immunocompromising conditions, including HIV infection and functional or anatomic asplenia such as sickle cell disease; CSF leaks; or cochlear implants and who have not previously received PCV13.

These children should receive PCV13 regardless of whether they received PCV7 or PPSV23 previously, the statement says. Those who have received neither vaccine should receive PCV13 first, followed at least eight weeks later by PPSV23. Those who have already received PPSV23 should receive their PCV13 dose at least eight weeks after the PPSV23 dose.

Recommendations for the use of PCV13 in healthy children and for PPSV23 remain unchanged.

PCV13 is approved for the Vaccines for Children program through 18 years of age and will be covered by the Vaccine Injury Compensation Program (VICP), whereas PPSV23 is not covered by the VICP.

Dr. Byington and Dr. Yvonne A. Maldonado, Vice Chairperson of the Committee, did not respond to an email request for comments.

SOURCE: https://bit.ly/15mP4U3

Pediatrics 2014;134:1230-1233.

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