Experience with PCV7 Vaccination in Children Characterized as “At Risk”Experience with PCV7 Vaccination in Children Characterized as “At Risk”

Prof. L.SierrasesúmagaClínica Universitaria. University of Navarra.

Pamplona. Spain.

Prof. L.SierrasesúmagaClínica Universitaria. University of Navarra.

Pamplona. Spain.

Streptococcus pneumoniae (pneumococcus) remains a leading cause of serious illness among young children worldwide and is the most frequent cause of pneumonia, bacterie- mia, sinusitis, and acute otitis media (AOM).

Streptococcus pneumoniae (pneumococcus) remains a leading cause of serious illness among young children worldwide and is the most frequent cause of pneumonia, bacterie- mia, sinusitis, and acute otitis media (AOM).

165

203

61

INCIDENCE of IPD

< 2 y.< 2 y.

Can J Infect Dis Med Microbiol2006;17(1):19-26.Can J Infect Dis Med Microbiol2006;17(1):19-26.

> 150/100,000> 150/100,000

> 25/100,000 > 25/100,000 www.cdc.gov/ncidod/dband/abcswww.cdc.gov/ncidod/dband/abcs

INCIDENCE of IPD

MMWR 2000;49(No. RR-9)MMWR 2000;49(No. RR-9)

X 4X 4 X 4-10X 4-10X 2-3X 2-3

INCIDENCE of IPD

X 4-6X 4-6

Levine O.S. et al. PEDIATRICS 1999; 103, e28 Levine O.S. et al. PEDIATRICS 1999; 103, e28

INCIDENCE of IPD

Hjuler T. et al. Pediatrics 2008;122:e26–e32Hjuler T. et al. Pediatrics 2008;122:e26–e32

INCIDENCE of IPD

Pediatrics 2008;122:e26–e32Pediatrics 2008;122:e26–e32

MMWR 2000;49(No. RR-9)MMWR 2000;49(No. RR-9)

Lancet 1994; 344:1504

Lancet 1994; 344:1504

X 60 – 80 X 60 – 80

INCIDENCE of IPD

INCIDENCE of IPD

X 2.8 – 12.6X 2.8 – 12.6

MMWR 2000;49(No. RR-9)MMWR 2000;49(No. RR-9)

N Engl J Med 2003;349:435-45.N Engl J Med 2003;349:435-45.

INCIDENCE of IPD

> 0.15 g/ml (92% - 100%)> 0.15 g/ml (92% - 100%)

IMMUNOGENICITY

> 1 g/ml (51% - 90%)> 1 g/ml (51% - 90%)

IMMUNOGENICITYNSNS NSNS

> 9.0 μg/ml> 9.0 μg/ml

IMMUNOGENICITY

Pediatric Infectious Disease Journal • Volume 24, Number 5, 2005

IMMUNOGENICITY

IMMUNOGENICITY

HIV-infected children have similar quantitative antibody responses but poorer qualitative an-tibody responses to the PnCV.

HIV-infected children have similar quantitative antibody responses but poorer qualitative an-tibody responses to the PnCV.

Pediatric Infectious Disease Journal • Volume 24, Number 5, 2005Pediatric Infectious Disease Journal • Volume 24, Number 5, 2005

Clinical Infectious Diseases 2000;31:34–41

IMMUNOGENICITY

RECOMMENDATIONS

Eligible Groups

• All infants and children at least six weeks of age through 59 months old. • Groups identified by ACIP as being at “highest risk” include: infants,

toddlers through 24 months old, children with sickle cell disease or anatomic asplenia, chronic illnesses, immunocompromising conditions, or HIV infection;

• Groups at moderate risk include: toddlers 24-35 months old, children of

aboriginal populations, and children between 35 and 59 months old who attend out of home day care.

Eligible Groups

• All infants and children at least six weeks of age through 59 months old. • Groups identified by ACIP as being at “highest risk” include: infants,

toddlers through 24 months old, children with sickle cell disease or anatomic asplenia, chronic illnesses, immunocompromising conditions, or HIV infection;

• Groups at moderate risk include: toddlers 24-35 months old, children of

aboriginal populations, and children between 35 and 59 months old who attend out of home day care.

CONJUGATE VACCINE (PCV7) TO PREVENT PNEUMOCOCCAL DISEASE

RECOMMENDED PNEUMOCOCCAL CONJUGATE VACCINE (PCV7). SCHEDULE.

Recommended schedules for pneumococcal conjugate vaccine PCV7 vary with the age of the child and the presence of underlying conditions:

• As primary series all children should receive:• a 3 dose primary series and a booster dose if vaccination is begun at <

6 months of age;

• a 2 dose primary series and a booster if vaccination is begun between 7 and 11 months of age;

• a 2 dose primary series and no booster if vaccination is begun between 12 and 23 months of age.

• If primary vaccination is initiated at >23 months of age:

• Healthy children should receive a single dose of vaccine.

Recommended schedules for pneumococcal conjugate vaccine PCV7 vary with the age of the child and the presence of underlying conditions:

• As primary series all children should receive:• a 3 dose primary series and a booster dose if vaccination is begun at <

6 months of age;

• a 2 dose primary series and a booster if vaccination is begun between 7 and 11 months of age;

• a 2 dose primary series and no booster if vaccination is begun between 12 and 23 months of age.

• If primary vaccination is initiated at >23 months of age:

• Healthy children should receive a single dose of vaccine.

RECOMMENDATIONS

• High Risk Children > 23 months of age, (with functional or anatomic asplenia, HIV infection or AIDS, chronic illnesses (chronic cardiopulmonary disease, diabetes mellitus, or CSF leak), immunocompromising conditions (malignancies, chronic renal failure, nephrotic syndrome, or organ transplant) or who are receiving immunocompromising medications) should receive 2 doses of pneumococcal conjugate vaccine (PCV7).

• High Risk Children > 23 months of age, should receive a single dose of PPV23 after 2 doses of PCV7.

• Aboriginal children, 24-59 months old, who have received the PCV7, may receive a single dose of PPV23 vaccine after conjugate vaccination.

• The recommended and minimal interval between PCV7 and PPV23 vaccines is 2 months

• High Risk Children > 23 months of age, (with functional or anatomic asplenia, HIV infection or AIDS, chronic illnesses (chronic cardiopulmonary disease, diabetes mellitus, or CSF leak), immunocompromising conditions (malignancies, chronic renal failure, nephrotic syndrome, or organ transplant) or who are receiving immunocompromising medications) should receive 2 doses of pneumococcal conjugate vaccine (PCV7).

• High Risk Children > 23 months of age, should receive a single dose of PPV23 after 2 doses of PCV7.

• Aboriginal children, 24-59 months old, who have received the PCV7, may receive a single dose of PPV23 vaccine after conjugate vaccination.

• The recommended and minimal interval between PCV7 and PPV23 vaccines is 2 months

RECOMMENDATIONS

RECOMMENDED PNEUMOCOCCAL CONJUGATE VACCINE (PCV7). SCHEDULE.

RECOMMENDED FOLLOW - UP SERIES. SEQUENCIAL PCV7 / PPV23 SCHEDULE

• For children who are immunocompromised or who have functional or anatomical asplenia:

• If the child is < 10 years old, one dose of pneumococcal conjugate vaccine (PCV7) and 2 months later one dose of pneumococcal polysaccharide vaccine (PPV23) is recommended every 3 years after the previous dose;

• If the child is > 10 years old, a revaccination is recommended if more than 5 years have elapsed since the previous doses.

• For children who are immunocompromised or who have functional or anatomical asplenia:

• If the child is < 10 years old, one dose of pneumococcal conjugate vaccine (PCV7) and 2 months later one dose of pneumococcal polysaccharide vaccine (PPV23) is recommended every 3 years after the previous dose;

• If the child is > 10 years old, a revaccination is recommended if more than 5 years have elapsed since the previous doses.

RECOMMENDATIONS

EFFICACY

68% 68%

84.5% 84.5%

EFFICACY

Clinical Infectious Diseases 2007; 44:1428–33

EFFICACY

> 15 >> 15 >

> 59 >> 59 >

EFFICACY

EFFICACY

155

9

- 90%- 90%

144

161

EFFICACY

EFFICACY

Pediatr Infect Dis J 2004;23: 726–731

83%83%

EFFICACY

Lancet 2006; 368: 1495–502Lancet 2006; 368: 1495–502

EFFICACY

Limits of targeting only children with an identificable co-morbidity

Children with IPDChildren with IPD Children with an identifiable co-

morbidity

Children with an identifiable co-

morbidity

75 to 90% of all IPD cases occur in healthy children (i.e., those without any co-morbidity that might put

them at greater individual risk of IPD)

75 to 90% of all IPD cases occur in healthy children (i.e., those without any co-morbidity that might put

them at greater individual risk of IPD)

5 to 10% of all children have an identifiable co-morbidity putting them at

high individual risk of IPD

5 to 10% of all children have an identifiable co-morbidity putting them at

high individual risk of IPD

Immunization of only children with an identifiable co-morbidity will prevent a

small percentage of all IPD cases

Immunization of only children with an identifiable co-morbidity will prevent a

small percentage of all IPD cases

All ChildrenAll Children