Mark B. Levin, M.D.
John M. Cotton, M.D.
Timothy J. Patrick-Miller, M.D.
Louis J. Tesoro, M.D.
Helen M. Rose, M.D.
The
Pediatric Group, P.A.
66 Mt. Lucas Road,
Princeton, NJ 08540-2733
Telephone 609-924-4892, Fax 609-921-9380
website: www.pedgroup.com
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March, 2000
Pneumococcal Conjugate Vaccine is Now Available
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 2years 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.
Inabiltiy 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.
Let us know of any questions you may have regarding pneumococcal conjugate vaccine.
________________________________________________________________________
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