Pneumococcal immunization for children

Pneumococcal infections are caused by Streptococcus pneumoniae bacteria. They're the leading cause of ear infections and serious bacterial infections in children. Bacterial meningitis (a serious infection of the lining of the brain and spinal cord, as well as the surrounding fluid), blood infections, pneumonia and sinus infections often are caused by S. pneumoniae. At least 200 young children die each year from pneumococcal infections. The most serious illness often occurs in children younger than age 2 years.

Depending on your child's age, one of two vaccines is used. Both are inactivated vaccines. This means they contain dead forms of the S. pneumoniae bacteria. Pneumococcal polysaccharide vaccine (PPV23, Pnu-Immune 23 and Pneumovax 23, for example) has been in use since 1983 and was one of the first vaccines developed to prevent pneumococcal infection in children. Since PPV23 requires a more mature immune system in order for protective levels of antibodies to develop, it's usually given to children age 2 years and older.

Pneumococcal conjugate vaccine (PCV7 or Prevnar, for example) was approved by the U.S. Food and Drug Administration (FDA) in February 2000 for children ages 2 months to 5 years. Prevnar is more effective in children younger than age 2 years. The vaccine became part of the recommended childhood immunization schedule in October 2000. It's effective in preventing serious pneumococcal infections in infants and young children, who are most at risk for serious infection.

Note: A shortage of the pneumococcal conjugate vaccine ended in fall 2004. The CDC now recommends updates for children who missed doses due to the shortage.


Recommendations/dose
All children younger than age 2 years should receive the pneumococcal conjugate vaccine (PCV7). The number of doses varies with the age of the child at the first dose:
For infants, routine immunization involves four doses of PCV7, given at age 2 months, 4 months, 6 months and 12 to 15 months.
Children who begin the series between ages 7 months and 11 months receive two doses, two months apart. A third dose is given between ages 12 months and 15 months.
Children who begin the series between ages 12 months and 23 months receive two doses, two months apart.
Children between ages 2 years and 5 years should receive PCV7 if they're at high risk for serious complications from a pneumococcal infection. This includes children who:

have chronic disease, including heart disease, lung disease (not including asthma), diabetes, cirrhosis, and leaks in cerebrospinal fluid
have weakened immune systems due to cancer, cancer treatment, HIV, long-term steroid therapy, organ transplantation, kidney disease or a dysfunctional spleen (including sickle cell disease)
These high-risk children receive two doses of PCV7, two months apart, with one dose of PPV23 two months or more later.

An additional dose of PPV23 is recommended three to five years later for children who have sickle cell disease, lack a normally functioning spleen, are infected with HIV, or have a weak immune system.

High-risk children who received PCV7 when they were younger than age 2 years need one dose of PPV23 at age 2 years.

Healthy children between ages 2 and 5 years may also benefit from one dose of PCV7. This is especially true for those who:

are younger than age 3
are of Alaskan Native or American Indian descent
are of African American descent
attend group child care centers

Effectiveness
The two vaccines have different rates of effectiveness in preventing serious pneumococcal infections, such as blood infections or meningitis:
Pneumococcal polysaccharide vaccine (PPV23) is up to 70 percent effective in providing protection from 23 types of S. pneumoniae bacteria.
Pneumococcal conjugate vaccine (PCV7) is more than 90 percent effective in providing protection from the seven most common types of S. pneumoniae bacteria.

Side effects
Side effects are usually mild and most commonly include pain and redness at the injection site. PCV7 may also be followed by a mild fever. Rarely, side effects to PPV23 may include fever, muscle aches and a severe reaction at the injection site. An allergic reaction to either vaccine is possible, but is also rare.

Who should wait to get the vaccine?
Your child's doctor may postpone this vaccine if your child has a moderate to severe acute illness.

Who shouldn't get the vaccine?
Your child shouldn't get the vaccine if he or she has had a severe allergic reaction to a prior dose of the vaccine or any of its components.