PNEUMOCOCCAL VACCINE FOR INFANTS AND TODDLERS
FDA today approved the first vaccine to prevent invasive pneumococcal diseases in
infants and toddlers -- diseases which can cause brain damage and, in rare cases, death.
The vaccine prevents invasive diseases caused by the organism Streptococcus pneumonia
(also known as Pneumococcus) including bacteria (an infection of the bloodstream) and
meningitis, an infection of the lining of the brain or spinal cord.
The vaccine -- Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197Protein)--
will be marketed as Prevnar by a unit of Wyeth-Ayerst Laboratories, a Division of American
Home Products Corporation in Philadelphia, Pennsylvania.
Infants can receive the vaccine as a series of four inoculations administered at 2,4,6,
and 12-15 months of age. For children who cannot receive the vaccine starting at age two
months, it is recommended that parents see their health care provider for alternative
Prevnar is the first multivalent conjugate pneumococcal vaccine for children under the
age of two. It targets the most common seven strains of pneumococcus that account for
approximately 80 percent of invasive disease in infants. It is manufactured by attaching
the polysaccharides (purified surface components of the different strains) to a
genetically modified nontoxic form of the diphtheria toxin protein called CRM197.
"This new vaccine is great news for parents and their children because now, for
the first time, we have a highly effective way to prevent a major cause of meningitis and
serious blood infections in the most susceptible children -- those under two years of
age." said Dr. Jane Henney, Commissioner of Food and Drugs. "When we prevent
these infections, we are also preventing brain damage and mortality from pneumococcal
It is estimated that each year in the U.S. there are about 16,000 cases of pneumococcal
bacteremia and 1400 cases of pneumococcal meningitis among children under age five.
Children under the age of two are at highest risk for infection. In up to half the cases
of meningitis, brain damage and hearing loss occurs and about 10 percent die.
Clinical trials included a large multicenter safety and efficacy study conducted at
Northern California Kaiser Permanente in Oakland, Calif. The controlled, double- blind
trial enrolled approximately 38,000 children, about half of whom received Prevnar. The
vaccine was given at 2,4, 6 and 12-15 months of age along with routinely recommended
vaccines. In this trial, the vaccine was 100 percent effective in preventing invasive
pneumococcal disease caused by the seven strains of pneumococcus in the vaccine. The
vaccine was approximately 90 percent effective in preventing invasive disease for
illnesses caused by all pneumococcal subtypes.
This vaccine is not indicated for use in adults or as a substitute for other approved
pneumococcal polysaccharide vaccines approved for high risk children over the age of two.
Side-effects in the trials were generally mild and included local injection site
reactions, irritability, drowsiness and decreased appetite. Approximately 21 percent of
the children had fevers over 100.3 compared to about 14 percent in the control group not
The vaccine's effectiveness in preventing ear infections, another infection caused by
pneumococcus, has not been evaluated by FDA.
Meningitis is usually caused by a viral or bacterial infection. There are different
types of bacterial meningitis. Before the approval of the first Haemophilus influenza type
b (HIB) conjugate vaccine in 1990 for infants, Hib was the leading cause of bacterial
meningitis, but today Streptococcus pneumonia is one of the leading causes of bacterial
This is not a vaccine against ear infections as many think. It does decrease ear
infections somewhat but it is for preventing meningitis, bacteremia (blood infection ---
it killed Jim Hensen of the Muppets) and decrease pneumonia and ear infections caused by
Dose for ages:
0-6m -------- 3 doses and a booster at 15 months
6-12m ------ 2 doses and a booster at 15 months
12-24m ----- 2 doses
2-4y -------- 1 dose only is susceptible to infections.
>4y --------- not given usually
Some insurance companies are paying for it and some are not yet. We will give it
as soon as we can.
Here is the AAP handout for this vaccine:
Pneumococcal Infection and Vaccine
Pneumococcus is a type of bacteria that
can attack different parts of the body and cause many serious infections including
Bacteremia (blood stream)
Sinusitis (sinus membranes)
Otitis media (ears)
These infections can be dangerous to very young children, the elderly,
and people with certain high-risk health conditions.
What is pneumococcal infection?
Pneumococcal bacteria live naturally in humans in the back of the
nose. Many people carry the bacteria and never Set sick. In fact, being a carrier helps
boost one's natural immunity to the disease. Others are not immune and can get very sick
from the infections caused by the bacteria.
Pneumococcal infections occur most often during the winter months. They
spread from person to person the same way a cold or the flu spreads - by droplets passed
through the air from coughing or sneezing, and through direct contact such as touching
unwashed hands or kissing. The disease may spread quickly, especially in places where
there are a lot of children, like child care centers and preschools.
Very young children do not have fully developed immune systems. This
makes them more at risk from bacteria] infections like pneumococcus. In addition,
pneumococcal infections can be life threatening for people with certain health problems
HIV infection or other immune system disorders
White cell cancers like leukemia or lymphoma
Chronic lung, heart, or kidney disease
A removed spleen or one that doesn't work properly
Bone marrow or organ transplants
Common pneumococcal infections and their symptoms
Bacteremia and meningitis
Pneumococcal bacteremia and pneumococcal meningitis occur when pneumococcal bacteria
get into the bloodstream and/or the central nervous system. Bacteremia is the presence of
bacteria in the blood. Meningitis is an infection of the thin lining and blood vessels
that cover the brain and spinal cord. Symptoms of meningitis include High fever Stiff neck
Extreme tiredness and/or irritability
Loss of appetite
Pneumococcal pneumonia is a chest infection in which the lungs become filled with fluid.
Symptoms of pneumonia include
Cough that may bring up thick yellow-green or bloody mucus
Shortness of breath or chest pain
Hard and rapid breathing
Sinusitis occurs when the membranes lining the airfilled pockets in the bone of the face
(sinuses) swell. The sinus cavities may fill with fluid. Symptoms of sinusitis include
Pressure behind the eyes
Pain in the face
Trouble breathing through the nose
Postnasal drip or prolonged runny nose
Otitis media is an infection of the middle ear. Young children commonly develop middle ear
infections when they have colds, the flu, or other viral respiratory infections. Symptoms
of an ear infection include
Ear pain (very young children may pull at their ears because of the pain)
Restlessness or irritability
Diagnosis and treatment of pneumococcal infections
Your pediatrician will be able to tell if your child has a pneumococcal infection by your
child's symptoms, a physical examination, and looking at your child's medical history.
X-rays, blood tests, and sometimes a spinal tap also may be done to confirm pneumococcal
infection in your child.
Prompt treatment with antibiotics is usually effective. In addition,
your child may need bed rest and a lot of fluids. In some cases, your child may need to be
Unfortunately, some strains of the pneumococcal bacteria are developing
resistance to the antibiotics usually used to kill them. This means that other antibiotics
must be used. Your pediatrician will let you know which antibiotic is best for your child.
Prevention of pneumococcal infections
Teach your children to wash their hands regularly with soap and
water. This helps prevent the spread of infection.
Avoid dust, tobacco smoke, and other substances that may interfere with breathing
and make children more likely to set sick.
A vaccine now offers infants and young children protection against
pneumococcal infections. It is most effective against the major pneumococcal diseases -
bacteremia, meningitis, and pneumonia. The vaccine is minimally effective in preventing
otitis media and sinusitis. Pneumococcal vaccine is safe and can be given as a separate
injection at the same time as other immunizations.
Who should receive the vaccine?
The American Academy of Pediatrics recommends that all
children younger than 2 years of age receive the Heptavalent Pneumococcal Conjugate
Vaccine (PCV7 or Prevnar). A series of doses may be given at 2, 4, 6, and 12 to 15 months
of age. A "catch-up" immunization schedule is available for children who get a
Some children between the ages of 2 and 5 years who have
certain health problems also need pneumococcal vaccine because they are at higher risk of
getting serious infections. Two types of vaccines may be given to children in that group.
Your pediatrician can explain which vaccine is best for your child.
Pneumococcal vaccines may be given to some children 5
years of age and older, although the risk associated with pneumococcal infections is much
lower in older children.
Are there side effects to pneumococcal vaccines?
Most children have no side effects with pneumococcal
vaccines. Those side effects that do occur are mild and temporary. The possible side
Soreness, swelling, and redness where the shot was given
A mild-to-moderate fever
These symptoms may begin within 24 hours after the shot
and usually go away within 48 to 72 hours.
Talk to your pediatrician to see if your child should be
vaccinated for pneumococcal infection and about the possible reactions to these
The information contained in this publication should not be used as a
substitute for the medical care and advice of your pediatrician. There may be variations
in treatment that your pediatrician may recommend based on individual facts and
'Me American Academy of Pediatrics is an organization of 55,000 primary
care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists
dedicated to the health, safety, and well-being of infants, children, adolescents, and
Now available from the American Academy of Pediatrics ... Guide to Your Child's
Symptoms. More than 100 common symptoms are listed alphabetically and designed to
enable a parent to quickly identify a symptom, learn its possible cause, and determine how
best to proceed. To order this 266-page deluxe hardcover edition, send a check or money
order for $19,95, plus $5.50 shipping and handling, to: AAP Publications - Symptoms, PO
Box 747, Elk Grove Village, IL 60009-0747. Or visit the AAP Web site at http://www.aap.org
to order online.
Other parenting guides from the Academy include Caring for Your Baby
and Young Child. Birth to Age 5, Caring for Your School-age Child.
Ages 5 to 12, and Caring for Your Adolescent, Ages 12 to 21. These books (except
Caring for Your Adolescent) are available in softcover each for only $15.95, plus $5.50
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plus $5.50 shipping and handling.
American Academy of Pediatrics
138 SEPT 2000
Division of Publications
PO Box 747
Elk Grove Village, IL 60009-0747
Web site - http://wwwaap.org
All rights reserved.
Copyright NCM Publishers, Inc
The pneumococcus is the most common cause of
invasive pneumococcal disease (IPD) and acute otitis media in children. Although a
23-valent pneumococcal vaccine composed of purified capsular polysaccharide antigens of 23
pneumococcal serotypes (23PS) has long been available, like other polysaccharide antigens,
many of the pneumococcal serotypes in the vaccine have limited immunogenicity in children
younger than 2 to 3 years of age. With the recent licensure of a heptavalent pneumococcal
conjugate vaccine (Prevnar"', PCV7), which contains serotypes 4, 6B, 9V, 14, 18C,
19F, and 23F conjugated to CRM,197, a mutant diphtheria toxin, an important new tool is
available to prevent serious pneumococcal infections in children.
The American Academy of Pediatrics (AAP) recently issued
recommendations for the prevention of pneumococcal infections, including the use of
pneumococcal conjugate vaccine, pneumococcal polysaccharide vaccine, and antibiotic
prophylaxis (Pediatrics. 2000;106:367-376). These guidelines should be useful as
physicians incorporate pneumococcal conjugate vaccine into the routine childhood
According to Larry K. Pickering, MD, special consultant to the
director, National Immunization Program, Centers for Disease Control and Prevention, in
Atlanta, Georgia, the guidelines for use of pneumococcal conjugate vaccine from the
Advisory Committee on Immunization Practices will be available in late summer or early
fall and will be very similar to those issued by the AAP and the American Academy of
"The pneumococcal conjugate vaccine is an important vaccine, said Jon
Abramson, MD, chairperson of the AAP's Committee on Infectious Diseases and Weston M.
Kelsey Professor and Chair, Department of Pediatrics, Wake Forest University School of
Medicine, in Winston Salem, North Carolina. "Since Haemophilus influenzae type b
conjugate vaccine has proven so effective in preventing invasive disease in children
caused by that organism, the pneumococcal conjugate vaccine is the next vaccine to deal
with the causes of important systemic bacterial infections in children," Dr Abramson
told VACCINE BULLETIN.
At its June 2000 meeting, the ACIP added the pneumococcal conjugate
vaccine to the Vaccines for Children program. According to Dr Abramson, reimbursement
issues related to the pneumococcal conjugate vaccine are of concern and must be determined
state by state. "Even the universal purchase states differ with respect to vaccine
reimbursement," he added. The AAP is trying to deal with reimbursement issues to
smooth the process by which a new vaccine is rolled out once a recommendation is made.
Who should receive the pneumococcal conjugate vaccine? According to the
AAP, administration of PCV7 is of the highest priority for infants and toddlers 23 months
of age and younger and for children at high risk for pneumococcal disease because of
underlying illnesses. Currently, data are insufficient to support a recommendation for
universal immunization of any children older than 24 months of age, other than those who
are at high risk, according to the AAP.
Children 23 Months of Age and Younger
The PCV7 vaccine is recommended for routine administration to all
children 23 months and younger, at 2,4,6, and 12 to 15 months of age (Table 1). Each
0.5-mL dose of the vaccine should be administered intramuscularly. The initial 2month dose
should be given no earlier than 6 weeks of age; very-low-birth-weight infants (<1500 g)
should be immunized at the time they attain a chronological age of 6 to 8 weeks,
regardless of their calculated gestational age.
All children 23 months of age and younger who have not received doses
of PCV7 prior to 6 months of age should be given catch-up doses according to the schedules
given in Table 1:
- Children 7 to 11 months of age who have not previously received vaccine should
receive two doses at least 6 to 8 weeks apart, followed by a third dose at 12 to 15 months
of age or at least 6 to 8 weeks after the second dose.
- Children 12 to 23 months of age who have not been immunized previously should receive
two doses at least 6 to 8 weeks apart.
According to the AAP, infants should receive the PCV7 immunization
series in conjunction with other required childhood vaccines at the time of the first
regularly scheduled well-child visit after at least 6 weeks of age. For children 23 months
of age or younger who begin a catch-up immunization series at 7 months of age or older,
the PCV7 immunization series should start at the time of their next clinic visit,
including those visits that are not related to well-child care unless contraindicated.
Children 24 to 59 Months of Age at High Risk for I PD
The AAP recommends PCV7 vaccine for all children 24 to 59 months old
who are at high risk for IPD, i.e., rates of infection of at least 150 / 100,000 (Table
2). Among the conditions that render a child at high risk for IPD are sickle-cell disease,
other types of functional or anatomic asplenia, HIV infection, and primary immune
deficiency. Children who are receiving immunosuppressive drugs also are in the high risk
category for IPD.
Recommended schedules of pneumococcal immunization for high-risk
children who are 24 to 59 months of age and who may or may not have received prior doses
of 23PS or PCV7 vaccine are given in Table 3. These schedules advocate the use of both
23PS and PCV7 vaccines in older children.
The AAP policy statement points out that few data exist regarding the
safety and immunogenicity of combined regimens of PCV7 and 23PS vaccines, and no data are
available that address the efficacy of such regimens for the prevention of pneumococcal
disease. But immunogenicity data suggest that PCV7 induces a primary immune response that
will provide immune memory for the boosting of antibody to some serotypes contained in
23PS vaccine. Because 23PS vaccine provides a potential expansion of serotype coverage, it
is recommended for use in high risk children. However, because of concern that repeated
doses of 23PS vaccine may result in an increased incidence of local reactions,
recommendations for the number of doses and dose intervals for pneumococcal vaccines
(Table 3) should be carefully followed.
TABLE 1. RECOMMENDED SCHEDULE OF DOSES FOR PCV7, INCLUDING PRIMARY SERIES AND CATCH-UP
IMMUNIZATIONS, IN PREVIOUSLY UNVACCINATED CHILDREN*
Age at First Dose (months) Primary Series
doses, 6-8 weeks apart
dose at 12 -15 months of age
doses, 6-8 weeks apart
dose at 12-15 months of age
doses, 6-8 weeks apart
*Recommendations for high-risk groups are given in Table 3.
Booster doses to be given at least 6 to 8 weeks after the final dose of the primary
TABLE 2. CHILDREN AT HIGH RISK OF IPD
High Risk (IPD attack rate >150 cases/100,000/y)
1. Sickle-cell disease, congenital or acquired asplenia, or splenic dysfunction
2. Infection with HIV
Presumed High Risk (I PD attack rate not calculated)
1. Congenital immune deficiency: some B- (humoral) or T-lymphocyte deficiencies,
complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), or phagocytic
disorders (excluding chronic granulomatous disease.
2. Chronic cardiac disease (particularly cyanotic congenital heart disease and cardiac
3. Chronic pulmonary disease (including asthma treated with high-dose oral corticosteroid
4. Cerebrospinal fluid leaks
5. Chronic renal insufficiency, including nephrotic syndrome
6. Diseases associated with immunosuppressive therapy or radiation therapy (including
malignant neoplasms, leukemias, lymphomas, and Hodgkin's disease) and solid organ
7. Diabetes mellitus
Moderate Risk (I PD attack rate >20 cases/1 00,000/y)
1. All children 24-35 months of age
2. Children 36-59 months of age attending out-of-home care
3. Children 36-59 months of age who are of Native American (American Indian and Alaska
Native) or African-American descent
*Guidelines for the use of pneumococcal vaccines for children who have received bone
marrow transplants are currently undergoing revision.
Children 24 to 59 Months of Age at Moderate Risk for IPD
Data are inadequate to recommend routine universal administration of
PCV7 or 23PS vaccine to children greater than 24 months of age who are at moderate risk
for IPD (attack rates of at least 20/100,000 but less than those deemed high-risk).
Children who are considered to be at moderate risk for IPD include
- All children 24 to 35 months of age
- Children 36 to 59 months of age who attend out-of-home care (>4
hours weekly in the company of at least two unrelated children)
- Children 36 to 59 months of age who are of Native American (American
Indian and Alaska Native) or African American descent
Other factors that might be considered when establishing priorities for
possible elective immunization of children 24 to 59 months of age with a pneumococcal
- Social or economic disadvantage
- Residence in crowded or substandard housing/state of homelessness
- Chronic exposure to tobacco smoke
- History of severe or recurrent otitis media within the year prior to immunization or
prior tympanostomy tube placement
According to the AAP, PCV7 vaccine administered electively for children 24 to 59 months
of age should be given according to the schedule in Table 1. An alternative is
administration of a single dose of the 23PS vaccine for all children 2 years of age or
older. If PCV7 is used , a single dose of 23PS vaccine after administration of PCV7 should
be considered, particularly in children of American Indian descent, to provide broadened
pneumococcal serotype coverage. The dose of 23PS vaccine should be given no earlier than 6
to 8 weeks after the last dose of PCV7.
Healthy Children 5 Years of Age and Older
Health care professionals also may elect immunization with PCV7 or 23PS
vaccine for certain children 60 months of age or older, although the risks for IPD are
much lower in these older children, according to the AAP. Although data are limited,
studies of small numbers of children with sickle-cell disease and HIV suggest that PCV7 is
safe and immunogenic when administered to children up to 13 years of age. Therefore,
administration of a single dose of PCV7 to children of any age, particularly children at
high risk for IPD, is not contraindicated. However, 23PS also may be effective and
immunogenic in older children at increased risk of invasive or severe respiratory tract
infections caused by pneumococci. Therefore, immunization with a single dose of PCV7 or
23PS vaccine is acceptable. If both vaccines are used, they should be given 6 to 8 weeks
Use of Pneumococcal Vaccine in Children With Severe or
Recurrent Otitis Media
Pneumococcal polysaccharide vaccines have not been successful in
reducing the incidence of acute otitis media (AOM) in children of any age. Therefore, 23PS
vaccine is not recommended for the prevention of AOM. However, PCV7 vaccine has effected a
modest reduction (<10 ) in the incidence of AOM in children with a history of recurrent
AOM (defined as three or more episodes in 6 months or four or more episodes in the year
before vaccine administration). And PCV7 may be beneficial for children 24 to 59 months of
age who have not previously received pneumococcal vaccines and who have a history of
recurrent AOM or who have AOM complicated by placement of tympanostomy tubes.
Control of Pneumococcal Disease Among Children Attending Out-of-Home
Studies have found that rates of IPD among children attending
out-of-home care are 2- to 3-fold higher than those among other healthy children of the
same age group who are not enrolled in out-of-home care (defined as at least 4 hours per
week in out-of-home care shared with at least two unrelated children). Immunization with
23PS vaccine does not reduce nasopharyngeal carriage of pneumococci, and available data
are insufficient to determine efficacy of PCV7 in preventing or interrupting
nasopharyngeal carriage or transmission of pneumococcal infection in out-of home-care
settings where one or more invasive pneumococcal infections have occurred. Until
additional data become available, routine immunization with PCV7 or 23PS vaccine is not
recommended for children in out-of-home care, although the elective use of either vaccine
is not contraindicated.
Use of Pneumococcal Vaccines in Children With a History of
Children who have had IPD should receive all recommended doses of
pneumococcal vaccines (PCV7 or 23PS) appropriate for their age and underlying condition.
The full series of scheduled doses should be completed even if the series is interrupted
by an episode of IPD.
Pneumococcal Vaccines: General Recommendations
Either PCV7 or 23PS may be given concomitantly with other vaccines. A
separate syringe should be used for the injection of either type of pneumococcal vaccine,
which should be administered at a different site than other vaccines given during the same
visit. The concurrent administration of pneumococcal vaccine with diphtheria and tetanus
toxoids and acellular pertussis (DTaP) vaccine, H influenzae type b conjugate
vaccines, hepatitis B vaccine, inactivated poliovirus vaccine, measles-mumps-rubella
vaccine, and varicella vaccine has not been shown to meaningfully impair the immune
response to other vaccines.
Rates of local reactions after administration of PCV7 are similar to
those seen with H influenzae type b conjugate vaccines, although fever and local
reactions occur more often with PCV7. The PCV7 vaccine does not contain thimerosal.
In patients in whom elective splenectomy is performed for any reason,
immunization with PCV7 or 23PS should be performed at least 2 weeks before splenectomy.
Immunization should precede the initiation of immune-compromising therapy by at least 2
weeks, the AAP indicated. In general, pneumococcal vaccines should not be administered
during pregnancy, because the effects on the developing fetus are unknown.
Questions for the future
According to Jerome 0. Klein, MD, professor of pediatrics, Boston University School of
Medicine, in Boston, Massachusetts, questions that remain to be answered after
recommendations for use of pneumococcal conjugate vaccine are implemented include
- What pattern of pneumococcal disease will be seen in the first few years following
widespread use of the vaccine in infants and children?
- Will the incidence of pneumococcal bacteremia, meningitis, and pneumonia decline?
- Will carriage of pneumococcal vaccine types be reduced, and will carriage of nonvaccine
- Will the use of antibiotics for respiratory infections and suspected invasive disease
- Will the incidence of multidrug-resistant pneumococci decline? -
FREQUENTLY ASKED QUESTIONS ABOUT PNEUMOCCCAL CONJUGATE
The following Q&As were adapted from the "Doctors Frequently Asked
Questions" section of the Web site www.pneumo.com, which is provided as an
educational service of Wyeth Lederle Vaccines.
Q: In addition to the fact that the pneumococcal conjugate vaccine can be
given to children younger than 2 years, what are its benefits, compared with
the currently licensed polysaccharide pneumococcal vaccine?
Kathryn Edwards, MD, Vanderbilt University, Nashville, Tennessee: The
pneumococcal conjugate vaccine includes seven most common serotypes in children, whereas
the vaccine contains the 23 most common serotypes in adults and children.
The conjugate vaccine generates memory to the seven serotypes included in the vaccine,
while the 23-valent does not generate memory to the 23 serotypes in the vaccine. The
conjugate vaccine generates an immune response in children as young as 2 months of age,
while the 23-valent vaccine does not generate antibody until a child is 2 years of age.
The conjugate vaccine has been shown to prevent invasive pneumococcal disease in infants,
whereas the 23-valent vaccine has not.
Q: If a patient received the 23-valent pneumococcal vaccine at 2 years
of age, would he still need to receive the 7-valent pneumococcal conjugate vaccine
between the ages of 3 and 5 years?
Dr. Edwards: The use of pneumococcal conjugate vaccine booster doses in children
who have been immunized with the 23-valent vaccine at the age of 2 years has been
evaluated in a small number of studies to date. However, according to
the available studies, it appears that the conjugate
vaccine will result in a better antibody response than the 23-valent
vaccine. The conjugate vaccine also primes for a memory response, so that subsequent
boosters with the 23 valent vaccine would likely be very immunogenic. It has also been
shown that children first receiving the 23-valent vaccine followed by the conjugate
vaccine do not appear to have more frequent or severe local reactions.
Q: What about infants beginning the pneumococcal conjugate vaccine series at the
6-month well-child visit? Do they need the full four doses, or can an adequate response be
achieved with doses at the 6-, 9-, and I 2-month visits?
George H. McCracken, Jr, MD, University of Texas South western Medical School, Dallas: Three
doses of pneumococcal conjugate vaccine after 6 months will produce protective antibody
titers, but the infant could be unprotected at 2 to 6 months, especially if the mother did
not have adequate antibody titers to all seven serotypes at the time of birth. The 2-, 4-,
and 6-month regimen was studied because it was the time of other childhood immunizations
and also was the time H influenzae type b vaccine was given with such excellent
Q: What are the recommendations for use of the pneumococcal conjugate vaccine in
Dr. McCracken: For most premature infants, routine immunizations are given when
they reach 2 months of age, unless they remain
hospitalized for medical problems. I am sure there are few data on the immunogenicity of
the pneumococcal conjugate vaccine for most premature, low birth-weight babies, but
studies will be done in the near future. I would administer pneumococcal conjugate vaccine
to most premature infants when they
have reached 2 months of age.