What are the indications and repeat dose recommendations for Prevnar (Pneumococcal conjugate vaccine)

Prevnar (Pneumococcal Conjugate Vaccine) Indications and Repeat Dose Recommendations

Prevnar (pneumococcal conjugate vaccine) is indicated for all children aged 2-59 months for routine immunization, children aged 60-71 months with underlying medical conditions, and adults aged 18 years and older for prevention of invasive pneumococcal disease, with specific dosing schedules based on age and risk factors. 1

Primary Indications

Children

• Routine vaccination of all children aged 2-59 months 1
• Vaccination of children aged 60-71 months with underlying medical conditions that increase risk for pneumococcal disease 1
• Prevention of invasive pneumococcal disease caused by serotypes included in the vaccine 2
• Prevention of otitis media caused by vaccine serotypes in children aged 6 weeks through 5 years 2

Adults

• Prevention of invasive pneumococcal disease in adults aged 18 years and older 2
• Prevention of pneumonia in adults aged 18 years and older 2

Dosing Schedule for Children

Standard 4-Dose Schedule (Ages 2-15 months)

• 1st dose: 2 months of age (can be given as early as 6 weeks) 1
• 2nd dose: 4 months of age 1
• 3rd dose: 6 months of age 1
• 4th dose: 12-15 months of age 1

Catch-up Vaccination for Previously Unvaccinated Children

Ages 7-11 months:

• 3 doses total: First 2 doses at least 4 weeks apart, third dose at 12-15 months (at least 8 weeks after second dose) 1

Ages 12-23 months:

• 2 doses total: At least 8 weeks apart 1

Ages 24-59 months (healthy children):

• 1 dose total 1

Ages 24-71 months (with underlying medical conditions):

• 2 doses total: At least 8 weeks apart 1

Incomplete Vaccination Scenarios

Children <24 months with incomplete PCV vaccination:

• Children who received ≥1 dose of PCV7 should complete the series with PCV13 1
• Children aged 12-23 months who received 3 doses of PCV7 before age 12 months should receive 1 dose of PCV13 (at least 8 weeks after most recent dose) 1

Children ≥24 months with incomplete vaccination:

• Healthy children aged 24-59 months with any incomplete schedule: 1 dose of PCV13 1
• Children aged 24-71 months with underlying medical conditions who received <3 doses before age 24 months: 2 doses of PCV13 1

Supplemental Dosing

• A single supplemental dose of PCV13 is recommended for all children aged 14-59 months who have received 4 doses of PCV7 or another age-appropriate complete PCV7 schedule 1
• For children with underlying medical conditions, a supplemental PCV13 dose is recommended through age 71 months 1

Adult Dosing

• Adults aged 18 years and older: Single dose of PCV13/PCV20 2, 3

Special Populations

Premature Infants

• Should receive PCV at the recommended chronologic age concurrent with other routine vaccinations if medically stable 1
• Caution regarding risk of apnea in premature infants 2

Children with Underlying Medical Conditions

• Children aged 2-18 years with underlying medical conditions should receive PPSV23 (23-valent pneumococcal polysaccharide vaccine) after completing all recommended doses of PCV13 1
• Underlying conditions include: anatomic or functional asplenia, sickle cell disease, HIV infection, immunocompromising conditions, chronic illness including heart or lung disease, cerebrospinal fluid leaks, and diabetes mellitus 1, 4

Common Pitfalls and Caveats

• Interruption of the vaccination schedule does not require restarting the entire series or adding extra doses 1
• For children who have received ≥1 dose of PCV7, the series should be completed with PCV13 rather than restarting 1
• When transitioning from PCV7 to PCV13, a supplemental dose of PCV13 is needed for complete protection against additional serotypes 1
• During vaccine shortages, priority should be given to children at highest risk for invasive pneumococcal disease 1
• PCV13 and newer PCV20 have replaced older PCV7 formulations, offering broader serotype coverage 2