Pneumococcal Vaccines: Prevnar (7 valent pneumococcal vaccine, PCV7) and Pneumovax (23 valent pneumococcal vaccine, 23PS)
Prevnar and Pneumovax are vaccines that are given to prevent diseases caused by a bacteria named streptococcus pneumonia (pneumococci for short). This germ causes several very serious diseases such as bacteremia (bacterial infection of the blood), meningitis (infection of the brain and spinal cord), and pneumonia. Less serious diseases such as sinus infections and ear infections (otitis media) are also caused by this bacteria. Pneumococci are the most common cause of ear infections (otitis media). In recent years, this bacteria has developed significant resistance problems to many antibiotics which is very problematic. Because of the seriousness of the diseases mentioned above and the development of antibiotic resistance of this bacteria, this trend is concerning. To help combat this growing problem of resistance and to prevent pneumococcal disease, particularly in small children, Prevnar has been developed.
For years a vaccine named Pneumovax, which is active against 23 serotypes of pneumococci has been available. Because children younger than two years usually do not respond to this vaccine, it is ineffective if given before this age. Because the bulk of serious pneumococcal disease happens before the end of the second year of life, it was important to close this gap. Therefore in 2000 Prevnar was licensed for use in the United States. Prevnar protects against the seven most common strains of Pneumococcus that cause invasive disease. The vaccine is more immunogenic than Pneumovax because it is combined with a protein carrier that the body easily identifies as foreign. Therefore, Prevnar is given to children under the age of two and Pneumovax is the vaccine given to older individuals. We now recommend that all infants be given four doses of the Prevnar vaccine in the first year of life. The Pneumovax vaccine (23PS) protects against many different types of the pneumococcus bacteria and it is recommended that to be given to people over age 65 and children over age two who are at high risk for pneumococcal disease.
The American Academy of Pediatrics released their recommendations for the prevention of pneumococcal infections with pneumococcal vaccines on June 5, 2000. The AAP recommends the routine use of Prevnar for all children, four doses, during the first year of life.
For children older than a year who have never received Prevnar, the AAP recommends the use of Prevnar for all children 23 months and younger, and for children aged 24 to 59 months who are at high risk, including children with an immune deficiency, sickle cell disease, asplenia (children without a working spleen), HIV infection, chronic cardiac conditions, chronic lung problems (including asthma), cerebrospinal fluid leaks, chronic renal insufficiency (including nephrotic syndrome), diabetes mellitus, and children who are receiving immunosuppresive therapy (organ transplants, etc.) who have not had the vaccine in infancy. In addition, the ACIP has recommended a single dose of the Prevnar vaccine for American Indian, Alaskan Native and African-American children 24 to 59 months of age if they had not previously had the vaccine.
Children aged 24-59 months who have already received a dose of 23PS and who are at high risk should also receive 2 doses of Prevnar at least 6-8 weeks later and a second dose of 23PS in 3-5 years. High risk children who have completed the Prevnar series should also receive a dose of 23PS at 24 months of age.
Although not recommended routinely, all children aged 24-59 months may receive one dose of either the 23PS or Prevnar vaccine if desired by their parents.
Although it is approved for use up to age 9, it is recommended that Prevnar not be routinely given to children over 5 years old. The risk of invasive infection with the pneumococcus bacteria is much less in children over age 5. However, if desired, high risk children can receive either the older 23PS vaccine, which is cheaper, provides good coverage against 23 subtypes of the pneumococcus and produces a good antibody response in children of this age, or they can receive the newer vaccine.
Children with severe, recurrent or complicated otitis media (ear infections) also may experience a modest benefit from the Prevnar vaccine. Studies have shown that in children who received Prevnar Vaccination, the incidence of clinically diagnosed otitis media (ear infections) was modestly reduced by 7% to 8% and up to 23% for very frequent otitis media. This is defined as 5 episodes of ear infections in 6 months or 6 episodes in 12 months. The frequency of tympanostomy tubes was reduced by about 20% in children who received the Prevnar vaccine.
The incidence of adverse reactions (side effects) was low and limited to local reactions of erythema (redness) or swelling (less than an inch) at the site of injection in 33% to 43% of children. The incidence of fever was 26% when given with other routine vaccines. Rates of fever greater than 104 degrees Fahrenheit did not exceed 5%. Other reactions included drowsiness (27% to 49%), fussiness (37% to 39%) and decreased appetite (12% to18%) when given along with other childhood vaccines. Serious adverse reactions have not been a problem.
View the CDC Prevnar vaccine sheet here: vis-pcv.pdf
View the CDC Pneumovax vaccine sheet here: vis-ppv.pdf