Transcript Document

Childhood Vaccines
DTaP, Polio, HiB, Hep B,
Prevnar
Continuity Clinic Lecture
July 9, 2009
Objectives:




Brief review of diseases
Individual and combination vaccines
Vaccine Schedules
Side Effects and Contraindications
Diphtheria





Greek diphthera (leather hide)
Recognized by Hippocrates in
5th century BCE
Epidemics described in
6th century
C. diphtheriae described by Klebs in
1883
Toxoid developed in 1920s
Corynebacterium diphtheriae



Aerobic gram-positive bacillus
Toxin production occurs only
when C. diphtheriae infected by virus
(phage) carrying tox gene
If isolated, must be distinguished from
normal diphtheroid
Diphtheria Clinical Features

Incubation period 2-5 days
(range, 1-10 days)

May involve any mucous membrane

Classified based on site of infection






anterior nasal
pharyngeal and tonsillar
laryngeal
cutaneous
ocular
genital
Pharyngeal and Tonsillar Diphtheria




Insidious onset of exudative
pharyngitis
Exudate spreads within 2-3 days
and may form adherent membrane
Membrane may cause respiratory
obstruction
Fever usually not high but patient
appears toxic
Diphtheria Complications




Most attributable to toxin
Severity generally related to extent
of local disease
Most common complications are
myocarditis and neuritis
Death occurs in 5%-10% for
respiratory disease
Diphtheria Antitoxin




Produced in horses
First used in the U.S. in 1891
Used only for treatment of
diphtheria
Neutralizes only unbound toxin
Diphtheria Epidemiology

Reservoir
Human carriers
Usually asymptomatic

Transmission

Temporal pattern
Winter and spring

Communicability
Up to several weeks
without antibiotics
Respiratory
Skin and fomites rarely
Cases
Diphtheria - United States, 19402007
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1940
1950
1960
1970
Year
1980
1990
2000
Diphtheria - United States, 19802007
6
5
Cases
4
3
2
1
0
1980
1985
1990
1995
Year
2000
2005
Diphtheria – United States, 1980-2004
Age Distribution of Reported Cases
25
Cases
20
15
10
5
0
<5
N=53
5-14
15-24
25-39
Age group (yrs)
40-64
65+
Routine DTaP Primary
Vaccination Schedule
Dose
Primary 1
Primary 2
Primary 3
Primary 4
Age
Interval
2 months
--4 months
4 wks
6 months
4 wks
15-18 months 6 mos
Routine DTaP Schedule for Children
Younger Than 7 Years of Age
Booster Doses



4 through 6 years of age, before
entering school
11 or 12 years of age if 5 years
since last dose (Tdap)
Every 10 years thereafter (Td)
Diphtheria and Tetanus Toxoids
Adverse Reactions




Local reactions (erythema,
induration)
Exaggerated local reactions (Arthustype)
Fever and systemic symptoms not
common
Severe systemic reactions rare
Diphtheria and Tetanus Toxoids
Contraindications and Precautions


Severe allergic reaction to vaccine
component or following a prior dose
Moderate or severe acute illness
Tetanus




First described by Hippocrates
Etiology discovered in 1884 by
Carle and Rattone
Passive immunization used for
treatment and prophylaxis during
World War I
Tetanus toxoid first widely used
during World War II
Clostridium tetani




Anaerobic gram-positive, sporeforming bacteria
Spores found in soil, animal feces;
may persist for months to years
Multiple toxins produced with
growth of bacteria
Tetanospasmin estimated human
lethal dose = 2.5 ng/kg
Tetanus Pathogenesis




Anaerobic conditions allow germination
of spores and production of toxins
Toxin binds in central nervous system
Interferes with neurotransmitter release
to block inhibitor impulses
Leads to unopposed muscle contraction
and spasm
Tetanus Clinical Features





Incubation period; 8 days
(range, 3-21 days)
Three clinical forms: local (not common),
cephalic (rare), generalized (most common)
Generalized tetanus: descending symptoms of
trismus (lockjaw), difficulty swallowing, muscle
rigidity, spasms
Spasms continue for 3-4 weeks
Complete recovery may take months
Neonatal Tetanus



Generalized tetanus in newborn
infant
Infant born without protective
passive immunity
Estimated more than 250,000
deaths worldwide in 2000-2003*
*www.who.int/immunization_monitoring/diseases/neonatal_tetanus/en/index.html
Tetanus Complications

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Laryngospasm
Fractures
Hypertension
Nosocomial infections
Pulmonary embolism
Aspiration pneumonia
Death
Tetanus Epidemiology

Reservoir
Soil and intestine of
animals and humans

Transmission
Contaminated wounds
Tissue injury

Temporal pattern
Peak in summer or
wet season

Communicability
Not contagious
Tetanus—United States, 1947-2007
700
600
Cases
500
400
300
200
100
0
1950
1960
*2005 provisional total
1970
Year
1980
1990
2000
Cases
Tetanus—United States, 1980-2007
100
90
80
70
60
50
40
30
20
10
0
1980
1985
*2005 provisional total
1990
1995
Year
2000
Tetanus Toxoid


Formalin-inactivated tetanus toxin
Schedule Three or four doses + booster
Booster every 10 years

Efficacy Approximately 100%

Duration Approximately 10 years

Should be administered with diphtheria toxoid as
DTaP, DT, Td, or Tdap
Pertussis

Highly contagious respiratory infection
caused by Bordetella pertussis

Outbreaks first described in 16th century

Bordetella pertussis isolated in 1906

Estimated 294,000 deaths worldwide
in 2002
Bordetella pertussis


Fastidious gram-negative bacteria
Antigenic and biologically active
components:






pertussis toxin (PT)
filamentous hemagglutinin (FHA)
agglutinogens
adenylate cyclase
pertactin
tracheal cytotoxin
Pertussis Pathogenesis



Primarily a toxin-mediated disease
Bacteria attach to cilia of respiratory
epithelial cells
Inflammation occurs which interferes
with clearance of pulmonary secretions
Pertussis Clinical Features



Incubation period 5-10 days (range
4-21 days)
Insidious onset, similar to minor
upper respiratory infection with
nonspecific cough
Fever usually minimal throughout
course of illness
Pertussis Clinical Features



Catarrhal stage
1-2 weeks
Paroxysmal
cough stage
1-6 weeks
Convalescence
Weeks to
months
Pertussis Among Adolescents
and Adults




Disease often milder than in infants and
children
Infection may be asymptomatic, or may
present as classic pertussis
Persons with mild disease may transmit
the infection
Older persons often source of infection
for children
Pertussis Deaths in the United
States, 2004-2006
Age at onset
2004
<3 mos
>3 mos
Total
2005
24
3
27
32
7
39
13
3
16
69
13
82
(84%)
(16%)
2006
Total
CDC, unpublished data, 2007
Pertussis Complications by Age*
Pneumonia
Hospitalization
70
60
Percent
50
40
30
20
10
0
<6 m
6-11 m
1-4 y
5-9 y
10-19 y
Age group
*Cases reported to CDC 1997-2000 (N=28,187)
20+ y
Pertussis—United States, 1940-2007
250000
Cases
200000
150000
100000
50000
0
1940
1950
1960
1970
Year
1980
1990
2000
Pertussis—United States, 1980-2007
30000
25000
Cases
20000
15000
10000
5000
0
1980
1985
1990
1995
Year
2000
2005
Reported Pertussis by Age Group,
1990-2007
<11
11-18
>18
30000
Cases
25000
20000
15000
10000
5000
0
1990
1995
2000
Year
2005
Whole-Cell Pertussis Vaccine

Developed in mid-1930s and
combined as DTP in mid-1940s

70%-90% efficacy after 3 doses

Protection for 5-10 years

Local adverse reactions common
Pertussis-containing Vaccines

DTaP (pediatric)


approved for children 6 weeks through 6
years (to age 7 years)
Tdap (adolescent and adult)

approved for persons 10 through 64 years
(Boostrix) and 11 through 64 years
(Adacel)
DTaP Fourth Dose


Recommended at 15-18 months*
May be given at 12 months of age if:



child is 12 months of age, and
6 months since DTaP 3rd dose, and
unlikely to return at 15-18 months
*15-20 months for Daptacel
School Entry (Fifth) Dose


Fifth dose recommended when 4th
dose given before age 4 years
All DTaP vaccines are licensed for
5th dose after DTaP series
Interchangeability of Different Brands of DTaP
Vaccine



Whenever feasible, the same DTaP
vaccine should be used for all doses of
the series
Limited data suggest that “mix and
match” DTaP schedules do not
adversely affect safety and
immunogenicity
If vaccine used for earlier doses is not
known or not available, any brand may
be used to complete the series
Pediarix





DTaP – Hep B – IPV combination
Minimum age 6 weeks
Approved for 3 doses at 2, 4 and
6 months
Not approved for booster doses
Licensed for children 6 weeks to
7 years of age
Pediarix



May be used interchangeably with
other pertussis-containing vaccines
if necessary
Can be given at 2, 4, and 6 months
in infants who received a birth dose
of hepatitis B vaccine (total of 4
doses)
May be used in infants whose
mothers are HBsAg positive or
ACIP recommendation
status *off-label
unknown*
www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/1003hepb.pdf
Pentacel Vaccine



Contains lyophilized Hib (ActHIB)
vaccine that is reconstituted with a
liquid DTaP-IPV solution
Approved for doses 1 through 4 among
children 6 weeks through 4 years of age
The DTaP-IPV solution should not be
used separately (i.e., only use to
reconstitute the Hib component)
DTaP Adverse Reactions

Local reactions
20%-40%
(pain, redness, swelling)

Temp of 101oF
3%-5%
or higher


More severe adverse reactions
not common
Local reactions more common
following 4th and 5th doses
Adverse Reactions Following the 4th
and 5th DTaP Dose



Local adverse reactions and fever
increased with 4th and 5th doses
of DTaP
Reports of swelling of entire limb
Extensive swelling after 4th dose
NOT a contraindication to 5th dose
Adverse Reactions Reported Following 1st and
4th Doses of Infanrix
Infanrix1
40
Infanrix4
35
35
Percent
30
26
26
25
20
15
10
5
4
6
2
0
Swelling
Pain
Symptom or sign
Source: Infanrix package insert, 2003
Temp >101.4F
DTaP Contraindications


Severe allergic reaction to vaccine
component or following a prior dose
Encephalopathy not due to another
identifiable cause occurring within 7
days after vaccination
DTaP Precautions*





Moderate or severe acute illness
Temperature >105°F (40.5°C) or higher
within 48 hours with no other identifiable
cause
Collapse or shock-like state (hypotonic
hyporesponsive episode) within 48 hours
Persistent, inconsolable crying lasting >3
hours, occurring within 48 hours
Convulsions with or without fever
occurring within 3 days
*may consider use in outbreaks
Haemophilus influenzae type b



Severe bacterial infection,
particularly among infants
During late 19th century believed to
cause influenza
Immunology and microbiology
clarified in 1930s
Haemophilus influenzae




Aerobic gram-negative bacteria
Polysaccharide capsule
Six different serotypes (a-f) of
polysaccharide capsule
95% of invasive disease caused
by type b
Haemophilus influenzae type b
Pathogenesis



Organism colonizes nasopharynx
In some persons organism invades
bloodstream and cause infection at
distant site
Antecedent upper respiratory tract
infection may be a contributing
factor
Haemophilus influenzae type b
Clinical Features*
Epiglottitis
17%
Meningitis
50%
Pneumonia
15%
Osteomyelitis
2%
Arthritis
8%
Cellulitis
6%
Bacteremia
2%
*prevaccination era
Haemophilus influenzae type b
Epidemiology

Reservoir
carriers
Human
Asymptomatic

Transmission
Respiratory droplets

Temporal pattern
Peaks in Sept-Dec
and March-May

Communicability
Generally limited but
higher in some
circumstances
Incidence*of Invasive Hib Disease, 1990-2007
25
Incidence
20
15
10
5
0
1990
1992
1994
1996
1998
Year
2000
2002
*Rate per 100,000 child *Rate per 100,000 children
<5 years of age
2004
2005
Incidence
Haemophilus influenzae type b, 1986
Incidence* by Age Group
200
180
160
140
120
100
80
60
40
20
0
0-1
12-13
24-25
36-37
Age group (mos)
*Rate per 100,000 population, prevaccine era
48-49
60
Haemophilus influenzae type b—United
States, 2002-2006



Incidence has fallen more than 99%
since prevaccine era
123 confirmed Hib cases reported
(average of 25 cases per year)
Most recent cases in unvaccinated
or incompletely vaccinated children
Haemophilus influenzae type b Conjugate
Vaccines



Two conjugate vaccines licensed for use
in infants as young as 6 weeks of age
Use different carrier proteins
3 doses of any combination confers
protection
Conjugate Hib Vaccines*
PRP-T
ActHIB, TriHIBit,
Pentacel
PRP-OMP
PedvaxHIB, Comvax
*HbOC (HibTiter) no longer available in the United States
Haemophilus influenzae type b Vaccine
Routine Schedule
Vaccine 2 mo
4 mo
PRP-T
x
x
PRP-OMP
x
x
6 mo 12-18 mo
x
x
x
Haemophilus influenzae type b Vaccine




Recommended interval 8 weeks for
primary series doses
Minimum interval 4 weeks for primary
series doses
Vaccination at younger than 6 weeks
of age may induce immunologic
tolerance to Hib antigen
Minimum age 6 weeks
Haemophilus influenzae type b
Vaccine Interchangeability


Both conjugate Hib vaccines (except
TriHIBit) are interchangeable for primary
series and booster dose
3 dose primary series if more than one
brand of vaccine used
Haemophilus influenzae type b Vaccine
Delayed Vaccination Schedule



Unvaccinated children 7 months of age or
older may not need entire 3 or 4 dose
series
Number of doses child requires depends
on current age
All children 15-59 months of age need at
least 1 dose
TriHIBit




ActHIB reconstituted with Tripedia
Not approved for the primary series
at 2, 4, or 6 months of age
Approved for the fourth dose of the
DTaP and Hib series only
Primary series Hib doses given as
TriHIBit should be disregarded
TriHIBit
•
•
May be used as the booster dose of
the Hib series at 12 months of age or
older following any Hib vaccine series*
Should not be used if child has receive
no prior Hib doses
*booster dose should follow prior dose by at least 2 months
COMVAX




Hepatitis B-Hib combination
Use when either antigen is indicated
Cannot use before 6 weeks of age
May be used in infants whose mothers are
HBsAg positive or status is unknown
Comvax Minimum Intervals



Package insert implies 8 to 11month interval between doses 2
and 3
This applies only if dose 2 given at
4 months of age
Minimum interval if not on schedule
is TWO months (minimum age 12
months)
Haemophilus influenzae type b Vaccine
Adverse Reactions



Swelling, redness, or pain in 5%30% of recipients
Systemic reactions infrequent
Serious adverse reactions rare
Haemophilus influenzae type b Vaccine
Contraindications and Precautions



Severe allergic reaction to vaccine
component or following a prior dose
Moderate or severe acute illness
Age less than 6 weeks
Poliomyelitis




First described by Michael Underwood
in 1789
First outbreak described in U.S.
in 1843
21,000 paralytic cases reported in the
U. S. in 1952
Global eradication in near future
Poliovirus





Enterovirus (RNA)
Three serotypes: 1, 2, 3
Minimal heterotypic immunity
between serotypes
Rapidly inactivated by heat,
formaldehyde, chlorine, ultraviolet
light
Most poliovirus infections are
asymptomatic
Poliomyelitis Pathogenesis





Entry into mouth
Replication in pharynx, GI tract,
local lymphatics
Hematologic spread to lymphatics
and central nervous system
Viral spread along nerve fibers
Destruction of motor neurons
Outcomes of Poliovirus Infection
Asymptomatic
Aseptic menigitis
0
20
Minor non-CNS illness
Paralytic
40
60
Percent
80
100
Poliovirus Epidemiology

Reservoir

Transmission

Communicability
onset
Human
Fecal-oral
Oral-oral possible
7-10 days before
Virus present in stool
3-6 weeks
Poliomyelitis—United States, 1950-2007
25000
Inactivated vaccine
Cases
20000
15000
10000
Live oral vaccine
Last indigenous case
5000
0
1950
1960
1970
1980
1990
2000
Poliomyelitis—United States, 1980-2007
14
VAPP
12
Imported
Cases
10
8
6
4
2
*
0
1980
1985
1990
1995
2000
*Vaccine-acquired paralytic polio (VAPP) in a U.S. resident
acquired outside the U.S.
2005
Poliovirus Vaccine

1955
Inactivated vaccine

1961
Types 1 and 2 monovalent OPV

1962
Type 3 monovalent OPV

1963
Trivalent OPV

1987
Enhanced-potency IPV (IPV)
Inactivated Polio Vaccine (IPV)




Contains 3 serotypes of vaccine virus
Grown on monkey kidney (Vero) cells
Inactivated with formaldehyde
Contains 2-phenoxyethanol, neomycin,
streptomycin, polymyxin B
Oral Polio Vaccine (OPV)




Contains 3 serotypes of vaccine virus
Grown on monkey kidney (Vero) cells
Contains neomycin and streptomycin
Shed in stool for up to 6 weeks following
vaccination
Inactivated Polio Vaccine
Highly effective in producing
immunity to poliovirus
 >90% immune after 2 doses
 >99% immune after 3 doses
 Duration of immunity not
known with certainty

Oral Polio Vaccine




Highly effective in producing
immunity to poliovirus
50% immune after 1 dose
>95% immune after 3 doses
Immunity probably lifelong
Polio Vaccination
Recommendations, 1996-1999



Increased use of IPV (sequential
IPV- OPV schedule) recommended
in 1996
Intended to reduce the risk of
vaccine- associated paralytic polio
(VAPP)
Continued risk of VAPP for contacts
of OPV recipients
Polio Vaccination Recommendations



Exclusive use of IPV recommended
in 2000
OPV no longer routinely available in
the United States
Indigenous VAPP eliminated
Polio Vaccination Schedule
Age
Vaccine
2 months
IPV
4 months
IPV
6-18 months
IPV
4-6 years*
IPV
Minimum
Interval
--4 wks
4 wks
4 wks
*the fourth dose of IPV may be given as early
as 18 weeks of age
Schedules that Include
Both IPV and OPV



Only IPV is available in the
United States
Schedule begun with OPV should be
completed with IPV
Any combination of 4 doses of IPV and
OPV by 5 years constitutes a complete
series
Combination Vaccines That Contain IPV

Pediarix


Kinrix


DTaP, Hepatitis B and IPV
DTaP and IPV
Pentacel

DTaP, Hib and IPV
KINRIX




Contains DTaP (Infanrix) and IPV
Approved ONLY for the 5th dose of DTaP
and 4th dose of IPV in children 4 through
6 years of age*
Do NOT use for earlier doses in the
DTaP or IPV series
Use of KINRIX for any dose other than
DTaP5 and IPV4 is off-label, and should
be considered a medication error
*whose previous doses have been with Infanrix and/or
Pediarix for the first 3 doses and Infanrix for the 4th dose
Polio Vaccine Adverse Reactions



Rare local reactions (IPV)
No serious reactions to IPV have
been documented
Paralytic poliomyelitis (OPV)
Vaccine-Associated Paralytic Polio
(VAPP) 1980-1998




Healthy recipients of OPV
Healthy contacts of
OPV recipients
Community acquired
Immunodeficient
41%
31%
5%
24%
Polio Vaccine
Contraindications and Precautions


Severe allergic reaction to a vaccine
component or following a prior dose of
vaccine
Moderate or severe acute illness
Polio Eradication




Last case in United States in 1979
Western Hemisphere certified polio free in
1994
Last isolate of type 2 poliovirus in India in
October 1999
Global eradication goal
Hepatitis B



Epidemic jaundice described by Hippocrates
in 5th century BCE
Jaundice reported among recipients of
human serum and yellow fever vaccines in
1930s and 1940s
Serologic tests developed in 1970s
Hepatitis B Virus




Hepadnaviridae family (DNA)
Numerous antigenic components
Humans are only known host
May retain infectivity for more than
7 days at room temperature
Hepatitis B Virus Infection




More than 350 million chronically
infected worldwide
Established cause of chronic
hepatitis and cirrhosis
Human carcinogen—cause of up to
80% of hepatocellular carcinomas
More than 600,000 deaths
worldwide in 2002
Hepatitis B Clinical Features




Incubation period 60-150 days
(average 90 days)
Nonspecific prodrome of malaise,
fever, headache, myalgia
Illness not specific for hepatitis B
At least 50% of infections
asymptomatic
Hepatitis B Complications





Fulminant hepatitis
Hospitalization
Cirrhosis
Hepatocellular carcinoma
Death
Risk of Chronic HBV Carriage by
Age of Infection
100
Carrier risk (%)
90
80
70
60
50
40
30
20
10
0
Birth
1-6 mo
7-12 mo
Age of infection
1-4 yrs
5+ yrs
Hepatitis B Perinatal Transmission

If mother positive for HBsAg and HBeAg



70%-90% of infants infected
90% of infected infants become chronically infected
If positive for HBsAg only


5%-20% of infants infected
90% of infected infants become chronically infected
Hepatitis B—United States, 1978-2007
Decline among
men who have sex with men
30000
Decline among
IV drug users
25000
Cases
20000
15000
10000
Hepatitis B vaccine licensed
5000
0
1978 1980
1985
1990
Year
1995
2000
2005
HBV Disease Burden in the
United States

Prevaccine era


estimated 300,000 persons infected
annually, including 24,000 infants and
children
2005

estimated 51,000 infections
Hepatitis B Vaccine Formulations


Recombivax HB (Merck)
- 5 mcg/0.5 mL (pediatric)
- 10 mcg/1 mL (adult)
- 40 mcg/1 mL (dialysis)
Engerix-B (GSK)
- 10 mcg/0.5 mL (pediatric)
- 20 mcg/1 mL (adult)
Protection by Age Group and Dose*
Dose
Infants**
Teens and Adults***
1
16%-40%
20%-30%
2
80%-95%
75%-80%
3
98%-100%
90%-95%
*dka * Anti-HBs antibody titer of 10 mIU/mL or higher
** Preterm infants less than 2 kg have been shown to
respond to vaccination less often
*** Factors that may lower vaccine response rates are age
older than 40 years, male gender, smoking, obesity, and
immune deficiency
Hepatitis B Routine Schedule
Dose 1 Birth
Dose 2 one month of age
Dose 3 six months of age
Interval: dose 1-2 is 4 weeks
Interval: dose 2-3 is 8 weeks
Third Dose of
Hepatitis B Vaccine



Minimum of 8 weeks after second
dose, and
At least 16 weeks after first dose,
and
For infants, at least 24 weeks of
age
COMVAX




Hepatitis B-Hib combination
Use when either antigen is indicated
Cannot use at younger than 6 weeks of
age
May be used in infants whose mother
is HBsAg positive or status is unknown
Combination Vaccine Rule


The minimum intervals between
doses of a combination vaccine are
dictated by the single antigen with
the longest minimum intervals
For Pediarix the minimum intervals
are determined by the hepatitis B
component
Hepatitis B Vaccine
Adverse Reactions
Pain
at injection site
Mild
systemic complaints
(fatigue, headache)
Temperature
≤99.9°F
(37.7°C)
Severe
Rare
systemic reactions
Infants and
Adults
Children
13%-29%
3%-9%
11%-17%
0%-20%
1%
0.4%-6%
rare
rare
Hepatitis B Vaccine
Contraindications and Precautions


Severe allergic reaction to a vaccine
component or following a prior dose
Moderate or severe acute illness
Pneumococcal Disease




S. pneumoniae first isolated by Pasteur
in 1881
Confused with other causes of
pneumonia until discovery of Gram
stain in 1884
More than 80 serotypes described by
1940
First U.S. vaccine in 1977
Streptococcus pneumoniae
Gram-positive bacteria
 90 known serotypes
 Polysaccharide capsule important
virulence factor
 Type-specific antibody is protective

Pneumococcal Disease
Second most common cause of
vaccine-preventable death in
the U.S. (after influenza)
 Major clinical syndromes include
pneumonia, bacteremia, and
meningitis

Pneumococcal Disease in Children




Bacteremia without known site of
infection most common clinical
presentation
S. pneumoniae leading cause of
bacterial meningitis among children
younger than 5 years of age
Highest rate of meningitis among
children younger than 1 year of age
Common cause of acute otitis media
Burden of Pneumococcal
Disease in Children*
Syndrome
Cases
Bacteremia
13,000
Meningitis
700
Death
Otitis media
200
5,000,000
*Prior to routine use of pneumococcal conjugate vaccine
Invasive Pneumococcal Disease
Incidence by Age Group, 1998 and 2002
1998
2002
250
Rate *
200
150
100
50
0
<1
1
2-4
5-17
18-34 35-49 50-64
Age Group (Yrs)
* Rate per 100,000 population
Source: Active Bacterial Core Surveillance/EIP Network
65+
Direct Benefit of Vaccination: Invasive
Pneumococcal Disease (IPD) Among Children
Younger Than 5 Years of Age
Rate/100,000 children
younger
than 5 years
Before
vaccine
2006
100
24
All IPD
Vaccine
serotypes
80
0.5
Source: Active Bacterial Core Surveillance/EIP Network
Direct Effect of Vaccination: Invasive Pneumococcal
Disease Among Children <5 Years of Age, 1998/992006
Overall PCV7 type
Cases per 100,000
120
100
80
60
40
PCV7
introduction
20
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
Pneumococcal Vaccines

1977
14-valent polysaccharide
vaccine licensed

1983
23-valent polysaccharide
vaccine licensed (PPV23)

2000
7-valent polysaccharide
conjugate vaccinelicensed
(PCV7)
Pneumococcal Conjugate Vaccine


Pneumococcal polysaccharide
conjugated to nontoxic diphtheria toxin
(7 serotypes)
Vaccine serotypes account for 86% of
bacteremia and 83% of meningitis
among children younger than 6 years
of age
Pneumococcal Polysaccharide
Vaccine



Not effective in children younger than
2 years
60%-70% against invasive disease
Less effective in preventing
pneumococcal pneumonia
Pneumococcal Conjugate Vaccine




Highly immunogenic in infants and
young children, including those with
high-risk medical conditions
97% effective against invasive
disease caused by vaccine
serotypes
73% effective against pneumonia
7% reduction in all episodes of
acute otitis media
Pneumococcal Conjugate Vaccine
Recommendations


All children 24 months of age
Unvaccinated children 24-59 months
with a high-risk medical condition
MMWR 2000;49(RR-9):1-35
Pneumococcal Conjugate Vaccine
Recommendations





Doses at 2, 4, 6, months of age,
booster dose at 12-15 months of age
First dose as early as 6 weeks
Minimum interval of 4 weeks between
first 3 doses
At least 8 weeks between dose 3 and
dose 4
Unvaccinated children 7 months of
age or older require fewer doses
MMWR 2000;49(RR-9):1-35
Pneumococcal Vaccines Adverse
Reactions

Local reactions



30%-50%
10%-20%
Fever, myalgia



polysaccharide
conjugate
polysaccharide
conjugate
Severe adverse
reactions
<1%
15%-24%
rare
Pneumococcal Vaccines
Contraindications and Precautions


Severe allergic reaction to vaccine
component or following prior dose
of vaccine
Moderate or severe acute illness