What is the recommended use and schedule for Prevnar (pneumococcal conjugate vaccine)?

Prevnar (Pneumococcal Conjugate Vaccine): Recommended Use and Schedule

Primary Recommendation

All children aged 2-59 months should receive routine pneumococcal conjugate vaccination with a 4-dose series at 2,4,6, and 12-15 months of age, and all adults aged ≥50 years should receive a single dose of pneumococcal conjugate vaccine. 1, 2, 3

Pediatric Vaccination Schedule

Standard Infant Series

• Administer four doses at ages 2,4,6, and 12-15 months (the first dose may be given as early as 6 weeks of age, with the final dose given at least 2 months after the third dose) 1, 2, 4
• This schedule provides durable protection throughout childhood without requiring additional booster doses for healthy children 5

Catch-Up Schedule for Previously Unvaccinated Children

For children 7-11 months: Give 3 doses total—first 2 doses at least 4 weeks apart, third dose after the first birthday separated from the second dose by at least 2 months 4

For children 12-23 months: Give 2 doses at least 2 months apart 4

For children 24 months through 17 years: Give 1 dose 4

Children Previously Vaccinated with Lower-Valency PCV

• Children who received any doses of PCV7 should complete their series with PCV13 or newer formulations 1, 2
• All children aged 14-59 months who completed a PCV7 series should receive one supplemental dose of PCV13 (given at least 8 weeks after the last PCV7 dose) 1, 2
• Children aged 15 months through 17 years previously vaccinated with lower-valency PCV should receive a single dose of current PCV (administered at least 8 weeks after the last dose of lower-valency vaccine) 4

High-Risk Pediatric Populations

Children with Immunocompromising Conditions

Children aged 6-18 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants should receive PCV13 if not previously given 1, 5

Children aged 60-71 months with underlying medical conditions should receive a supplemental PCV13 dose 1, 2

Children aged 2-18 years with underlying medical conditions should receive PPSV23 after completing all recommended PCV13 doses (administered >2 months after the final PCV13 dose) 1, 2, 5

Cochlear Implant Recipients

• All children with cochlear implants should receive age-appropriate pneumococcal vaccination according to high-risk schedules 1
• Children aged 24-59 months with cochlear implants who completed PCV7 should receive PPSV23 >2 months after vaccination 1

Premature Infants

Premature infants should receive PCV at the recommended chronologic age (not corrected age) concurrent with other routine vaccinations if medically stable 2, 4

Adult Vaccination Schedule

Age-Based Recommendations

All adults aged ≥50 years who have never received a pneumococcal conjugate vaccine should receive a single dose of PCV20 or PCV21 3, 6

If PCV20 is unavailable, adults can receive PCV15 followed by PPSV23 at least 1 year later (or 8 weeks later for immunocompromised patients) 6

Adults with Risk Conditions

Adults aged 19-64 years with immunocompromising conditions, cochlear implants, or CSF leaks should receive the same vaccination schedule as those aged ≥65 years 6

Previously Vaccinated Adults

Adults who previously received only PPSV23 should receive PCV20 at least 1 year after their last PPSV23 dose 6

Key Clinical Considerations

Vaccine Interchangeability

• Interruption of the vaccination schedule does not require restarting the entire series or adding extra doses 2
• Different PCV formulations can be used to complete the series, though this should follow current ACIP guidance 1, 2

Concomitant Administration

• Pneumococcal vaccine can be administered at the same visit as influenza vaccine or other age-appropriate vaccines at different anatomic sites 6
• PCV13 administered concomitantly with trivalent inactivated influenza vaccine produces noninferior antibody responses compared to sequential administration 7

Common Pitfalls to Avoid

Do not delay vaccination if immunization records are unavailable—use verbal history to determine prior vaccination status 6

Do not withhold vaccination from premature infants based on corrected age—use chronologic age for scheduling 2, 4

During vaccine shortages, prioritize children at highest risk for invasive pneumococcal disease (those with immunocompromising conditions, functional asplenia, CSF leaks, or cochlear implants) 2

Do not assume that revascularization procedures or cardiovascular interventions eliminate the need for pneumococcal vaccination—patients with cardiovascular disease remain at high risk 6

Safety Profile

Pediatric Adverse Reactions

• Most common reactions in infants include irritability (>60%), injection site pain (>30%), drowsiness (>30%), decreased appetite and injection site redness (>20%) 4
• Local reactions typically resolve within 48 hours 6

Adult Adverse Reactions

• Most common reactions in adults aged 18-59 years include injection site pain (>70%), muscle pain (>50%), fatigue (>40%), and headache (>30%) 4
• In adults aged ≥60 years, injection site pain (>50%), muscle pain and fatigue (>30%), and headache (>20%) are most common 4
• Severe local or systemic reactions are rare, and neurologic complications like Guillain-Barré syndrome have not been causally associated with pneumococcal vaccination 6

Contraindications

Do not administer to individuals with a history of severe allergic reaction (anaphylaxis) to any vaccine component or to diphtheria toxoid 4