What vaccines are recommended to prevent pneumonia in pediatric patients?

Vaccines to Prevent Pneumonia in Pediatric Patients

All healthy infants should receive the 13-valent pneumococcal conjugate vaccine (PCV13) as a 4-dose series at 2,4,6, and 12-15 months of age, and all children ≥6 months should receive annual influenza vaccination to prevent pneumonia. 1

Core Pneumococcal Vaccination Schedule

Healthy Infants (Starting at 2-6 Months)

• Administer PCV13 at 2,4,6, and 12-15 months of age as the standard 4-dose series, with a minimum interval of 4 weeks between the first three doses and at least 8 weeks between the third and fourth doses 1, 2
• Premature infants (<37 weeks gestation) who are medically stable should receive PCV13 at the recommended chronologic age (not corrected age), concurrent with other routine vaccinations 1, 2
• The first dose can be administered as early as 6 weeks of age if needed 1

Catch-Up Vaccination for Older Infants (7-11 Months)

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

Catch-Up Vaccination for Children (12-23 Months)

• Administer 2 doses of PCV13 with an interval of at least 8 weeks between doses 1

Healthy Children (24-59 Months) Previously Unvaccinated

• Give a single dose of PCV13 1, 2
• No additional pneumococcal vaccines are needed after completing the series unless high-risk conditions develop 2

High-Risk Children Requiring Additional Protection

Children with High-Risk Medical Conditions (24-71 Months)

High-risk conditions include functional or anatomic asplenia, sickle cell disease, HIV infection, other immunocompromising conditions, cochlear implants, cerebrospinal fluid leaks, chronic heart or lung disease, and diabetes mellitus 1, 2

• If <3 doses received before age 24 months: Give 2 doses of PCV13, 8 weeks apart 1, 2
• If 3 doses received before age 24 months: Give 1 dose of PCV13, at least 8 weeks after the most recent dose 1, 2
• After completing all PCV13 doses: Administer PPSV23 (23-valent pneumococcal polysaccharide vaccine) at least 8 weeks after the last PCV13 dose for children aged 2-18 years with high-risk conditions 1, 2

Additional Vaccines for Pneumonia Prevention

Influenza Vaccination

• All children and adolescents ≥6 months of age should receive annual influenza vaccination to prevent both influenza-related pneumonia and secondary bacterial pneumonia (particularly pneumococcal and CA-MRSA pneumonia) 1
• Parents and caretakers of infants <6 months, including pregnant adolescents, should be immunized with influenza vaccine to protect infants from exposure 1

Haemophilus influenzae Type b (Hib) Vaccine

• Administer Hib conjugate vaccine according to the routine infant immunization schedule to prevent Hib pneumonia, which accounts for a significant proportion of pediatric pneumonia deaths globally 1

Pertussis Vaccination

• Ensure children receive DTaP vaccine on schedule to prevent pertussis-associated pneumonia 1
• Parents and caretakers of infants <6 months should receive Tdap vaccination 1

RSV Prophylaxis for High-Risk Infants

• High-risk infants (premature infants, those with chronic lung disease or hemodynamically significant congenital heart disease) should receive palivizumab (RSV-specific monoclonal antibody) to decrease the risk of severe RSV pneumonia and hospitalization 1

Evidence Supporting Pneumococcal Vaccination

The Advisory Committee on Immunization Practices (ACIP) recommendations are based on robust clinical trial data demonstrating that PCV13 (and its predecessor PCV7) is highly efficacious:

• 97.4% efficacy against invasive pneumococcal disease caused by vaccine serotypes among fully vaccinated infants 1, 2
• 27% reduction in chest X-ray-confirmed pneumonia meeting WHO criteria 1
• 6% reduction in clinical pneumonia of any etiology 1
• Significant reduction in acute otitis media episodes (6.4% fewer episodes overall, 9.1% fewer frequent AOM episodes) 1

Critical Pitfalls to Avoid

• Never use PPSV23 in children <2 years of age—it is only indicated for children ≥2 years with specific high-risk conditions 1, 2
• Do not restart the vaccination series if doses are interrupted—simply continue where you left off with appropriate intervals 1, 3
• Do not give routine PCV13 to healthy children ≥5 years—it is not recommended for this age group 2
• Do not forget to administer PPSV23 to high-risk children after completing PCV13—this provides broader serotype coverage essential for immunocompromised patients 1, 2
• Do not delay influenza vaccination—pneumococcal pneumonia after influenza infection is common, and influenza vaccination reduces this risk 1

Transition from PCV7 to PCV13

For children who previously received PCV7:

• Complete the series with PCV13 for all remaining doses 1, 2
• Children aged 14-59 months who completed a 4-dose PCV7 series should receive a single supplemental dose of PCV13 at least 8 weeks after the last PCV7 dose 1, 2
• Children aged 60-71 months with underlying medical conditions who completed PCV7 should receive a supplemental PCV13 dose 1