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Pneumococcal Conjugate Vaccine

April 01, 2000

by Mark B. Levin, M.D., Timothy J. Patrick-Miller, M.D. and Louis J. Tesoro, M.D. The Pediatric Group, P.A., Princeton

 

This is the twentyfourth article in a series written for Princeton Online.

Disease considerations: In the USA each year, pneumococcus causes 3000 cases of meningitis, 50,000 cases of blood infection, 500,000 cases of pneumonia, and 7,000,000 cases of otitis media. Pneumococcus is the bacterium responsible in children for 85% of blood infections, 66% of pneumonias, 50% of meningitis, 40% of otitis and 40% of sinusitis. Half of the cases of pneumococcal blood, lung and brain infections and most ear infections occur in children under 2 years of age. Children are at greater risk for pneumococcal disease if they are in day care (play over 4 hours per week with at least 2 other children), are exposed to cigarette smoke, have a history of ear infections or who have had recent exposure to antibiotics. Pneumococcus is particularly dangerous in children with kidney disease, sickle cell disease, diabetes, immunocompromised status or no spleen. Infections with pneumococcus tend to cause rapid inflammation resulting in more pain and higher fevers than other germs. Pneumococcus is rapidly becoming resistant to many antibiotics.

Vaccine considerations: This killed, thimerosal-free vaccine is chemically bound to a tiny amount of diphtheria protein to make it more effective than its predecessor, the pneumococcal polysaccharide vaccine. Because it is 90% effective in preventing disease caused by pneumococcus, it has been termed in the media as the “pneumonia vaccine” and the “ear infection vaccine”.

Schedule: Three initial doses given at least 4 to 8 weeks apart starting at 6 to 8 weeks of age. A booster is given at 12 to 15 months of age. Previously unimmunized children between 7 and 11 months of age require only 2 shots and a booster; those between 12 and 23 months of age require 1 shot and a booster; those over 2 and under 9 years of age require only 1 dose.

Duration of immunity: at least through childhood, perhaps much longer.

Side effects: The following may occur within 2-3 days of immunization and last for 2-3 days: Transient injection site inflammation (up to 36.5%), temperature over 100.4oF (<7 %), temperature up to 102.2oF (<1.4%), irritability (<7.3%), drowsiness (<5.2%), decreased appetite (<2.8%), vomiting (3.6%), diarrhea (5.4%) and hives (0.3%). There have been no reports of serious reactions to this vaccine in nearly 40,000 children studied. Allergic reactions are possible to any biological. Those who are allergic to latex may experience symptoms because of natural dry rubber in the packaging. Inability to clot normally may preclude immunization.

Cost Considerations: This new vaccine is more costly than many others. However, it is far less costly than an office visit and antibiotics for an ear infection, even excluding the cost of x-rays and lab tests for the more serious diseases caused by pneumococcus.

Our recommendations: The similarity in epidemiology between pneumococcus and Hib and the parallel evolution of the vaccines for both germs suggests that this is a very important step in controlling infections caused by this bacterium. We are strongly in favor of administering this vaccine to all children through age 5 and high risk children through 9 years.

Call your doctor with questions regarding this vaccine and how to obtain it for your child(ren).

 

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Dr. Timothy Patrick-Miller

Dr. Patrick-Miller has been a member of the staff at The Pediatric Group since 1985. Dr. Patrick-Miller has served on several Departmental and hospital committees. He has published original work while at The Pediatric Group. He and his wife enjoy travel. He also likes hiking, biking, gardening and reading.

Dr. Mark B. Levin 

Dr. Levin was a member of the staff at The Pediatric Group starting in 1977. He was an attending Pediatrician at the Medical Center at Princeton, Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin served on numerous Departmental and hospital committees. He published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group.

Dr. Louis J. Tesoro

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees and was Chairman, Department of Pediatrics, Medical Center at Princeton from 1996 - 2000. He has lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.

© The Pediatric Group April, 2000 All Rights Reserved

Moderated by Helen Rose.

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