Prevnar (Pneumococcal Conjugate Vaccine) - Recommended Use
Prevnar 13 (PCV13) or the newer Prevnar 20 (PCV20) should be administered as a 4-dose series at ages 2,4,6, and 12-15 months for all infants, with PCV20 now replacing PCV13 as the preferred formulation. 1, 2
Routine Infant Vaccination Schedule
- Administer a 4-dose series at 2,4,6, and 12-15 months of age (the first dose may be given as early as 6 weeks) 1, 2
- The fourth dose must be given at least 2 months after the third dose 2
- PCV20 (Prevnar 20) is the current formulation that replaced PCV13 in 2010, which itself replaced PCV7 in 2000 1, 2
Catch-Up Vaccination for Children 7 Months Through 17 Years
For unvaccinated children starting late, the number of doses depends on age at first dose: 2
- 7-11 months old: 3 doses total (first 2 doses at least 4 weeks apart; third dose after the first birthday, separated from second dose by at least 2 months) 2
- 12-23 months old: 2 doses at least 2 months apart 2
- 24 months and older through 17 years: Single dose 2
For children 15 months through 17 years previously vaccinated with lower valency vaccine (PCV7 or PCV13): administer a single dose of PCV20 at least 8 weeks after the last dose of the previous vaccine 2
High-Risk Children Requiring Additional Vaccination
Children aged 2-18 years with underlying medical conditions should receive both PCV13/PCV20 AND PPSV23: 1
High-risk conditions include: 1
- Anatomic or functional asplenia (including sickle cell disease)
- HIV infection or other immunocompromising conditions
- Chronic heart or lung disease
- Cerebrospinal fluid leaks
- Cochlear implants
- Diabetes mellitus
- Chronic renal insufficiency or nephrotic syndrome
For these high-risk children aged 24-59 months: vaccinate with PCV13/PCV20 first, then administer PPSV23 at least 8 weeks later (for immunocompromised) or at least 2 months later (for other chronic conditions) 1
For high-risk children with underlying medical conditions, a supplemental PCV13 dose is recommended through age 71 months (nearly 6 years) 1
Adult Vaccination (18 Years and Older)
Prevnar 20 is administered as a single dose for adults aged 18 years and older 2
- For adults ≥65 years with no prior pneumococcal vaccination: single dose of PCV20 (or PCV21 or PCV15 with PPSV23 to follow) 3
- For adults 19-64 years with risk conditions: single dose of PCV20 4
Clinical Efficacy Supporting These Recommendations
The original PCV7 demonstrated 97.4% efficacy against invasive pneumococcal disease in fully vaccinated infants 1, 2
- PCV7 showed 73% efficacy against consolidative pneumonia 1
- Moderate effectiveness against otitis media: 57% efficacy against vaccine-serotype AOM episodes 2
- 7% reduction in all otitis media episodes regardless of etiology 2
PCV13 and PCV20 contain the same 7 serotypes as PCV7 plus additional serotypes, manufactured using identical processes, supporting their comparable efficacy 1, 2
Common Pitfalls to Avoid
- Do not skip the fourth dose at 12-15 months - this booster is critical for long-term immunity and immunologic memory 5
- Do not confuse the catch-up schedules - children starting late need fewer doses, but the schedule varies significantly by age 2
- For high-risk children, do not forget PPSV23 - PCV alone is insufficient for children with immunocompromising conditions 1
- Respect the minimum intervals between PCV and PPSV23 - at least 8 weeks for immunocompromised children, at least 2 months for others 1
- Do not use live vaccines in children currently on biologics, but killed/inactivated vaccines like pneumococcal vaccines should be used 1
Safety Profile
Most common adverse reactions in infants include: 2
- Irritability (>60%)
- Injection site pain (>30%)
- Drowsiness (>30%)
- Decreased appetite and injection site redness (>20%)
- Fever (>10%)
Apnea has been observed in premature infants following intramuscular vaccination - decisions about timing should consider the individual infant's medical status 2