Which pneumococcal conjugate vaccine should be administered to healthy infants?

Pneumococcal Conjugate Vaccine for Healthy Infants

Healthy infants should receive PCV13 (13-valent pneumococcal conjugate vaccine) as a 4-dose series at 2,4,6, and 12-15 months of age. 1

Recommended Vaccination Schedule

For infants aged 2-6 months starting vaccination:

• Administer 3 primary doses at 2,4, and 6 months of age 1
• Minimum interval between primary doses is 4 weeks 1
• Give a booster dose at 12-15 months (at least 8 weeks after the third dose) 1, 2

Why PCV13 Over Other Formulations

PCV13 replaced the earlier PCV7 formulation in 2010 and is the current standard of care. 1 The vaccine contains the 7 serotypes from PCV7 (4, 6B, 9V, 14, 18C, 19F, 23F) plus 6 additional serotypes (1,3,5, 6A, 7F, 19A), providing broader protection against invasive pneumococcal disease. 1

Key efficacy data supporting PCV13:

• Demonstrated 97.4% efficacy against vaccine-type invasive pneumococcal disease 1
• Pooled vaccine efficacy of 80% for vaccine-type IPD and 58% for all-serotype IPD 1
• Reduces X-ray confirmed pneumonia by 27% and clinical pneumonia by 6% 1
• PCV13 elicits immune responses comparable to PCV7 for common serotypes while providing robust responses to the 6 additional serotypes 3, 4

Catch-Up Schedules for Delayed Vaccination

For infants aged 7-11 months (previously unvaccinated):

• Give 2 primary doses at least 4 weeks apart 1
• Follow with 1 booster dose at 12-15 months (at least 8 weeks after second dose) 1, 2

For children aged 12-23 months (previously unvaccinated):

• Administer 2 doses with at least 8 weeks between doses 1
• No booster dose needed 1

For healthy children aged 24-59 months (previously unvaccinated):

• Give 1 single dose 1

Safety Profile

PCV13 has a safety profile similar to PCV7 with no major safety concerns identified. 1 Common adverse events include injection site reactions (pain/tenderness 48.8%, erythema 46.6%, swelling 35.3%), irritability (70%), drowsiness (59.2%), and fever (36.9%). 1 Fever >39°C occurs in only 5.3% of recipients. 1

Important Clinical Considerations

Coadministration with other vaccines:

• PCV13 can be administered simultaneously with routine childhood vaccines if given in separate syringes at separate injection sites 1
• Does not interfere with immune responses to other pediatric vaccines 2, 3

Premature infants:

• Apnea following intramuscular vaccination has been observed in some premature infants 1
• Decisions about timing should consider individual medical status and balance benefits versus risks 1

Contraindications:

• Severe allergic reaction to any component of PCV13, PCV7, or any diphtheria toxoid-containing vaccine 1

Common Pitfalls to Avoid

• Do not use PPSV23 (23-valent polysaccharide vaccine) in healthy infants—this vaccine is reserved for children ≥2 years with specific high-risk conditions 1
• Do not restart the series if vaccination is interrupted—simply continue from where the child left off using age-appropriate catch-up schedules 5
• Minimum intervals must be respected: 4 weeks between primary series doses for infants <12 months, and 8 weeks for all other situations 1