'Permissive' Guidelines Revised by Vaccine Gestapo on Use of 7-Valent Pneumococcal Vaccine in Children

[Guest guest]

'Permissive' Guidelines Revised by Vaccine

Gestapo on Use of 7-Valent Pneumococcal Vaccine in Children

" Concern about limited vaccine supply and cost

was the basis underlying ACIP's rationale for

limiting the recommendation for routine

vaccination to children aged 24 to 59 months who

have certain underlying medical conditions or who are immunocompromised.

However, there have been adequate supplies of

PCV7 since September 2004. Furthermore, the

permissive recommendation for healthy children

aged 24 to 59 months was perceived as confusing

by some healthcare providers. Accordingly,

prompted by these considerations, the ACIP

Pneumococcal Vaccines Work Group reviewed

available data on safety and immunogenicity of

PCV7 in children aged 24 to 59 months, current

rates of PCV7-type invasive disease and of

vaccination coverage, and vaccine effectiveness postlicensure. "

<http://www.medscape.com/viewarticle/572568>http://www.medscape.com/viewarticle/\

572568

April 4, 2008 ­- The Advisory Committee on

Immunization Practices (ACIP) has issued updated

information on use of 7-valent pneumococcal

conjugate vaccine in children aged 24 to 59

months who are not completely vaccinated,

according to an article published in the April 4

issue of the Morbidity and Mortality Weekly Report.

" This notice updates the recommendation for use

of 7-valent pneumococcal conjugate vaccine (PCV7)

among children aged 24–59 months who are either

unvaccinated or who have a lapse in PCV7

administration, " the report states. " In February

2000, PCV7, marketed as Prevnar and manufactured

by Wyeth Vaccines (Collegeville, Pennsylvania),

was approved by the Food and Drug Administration

for use in infants and young children. "

Routine administration of PCV7 is as a 4-dose

series, given at ages 2, 4, 6, and 12 to 15

months. For children younger than 23 months,

catch-up immunization is recommended, using fewer

doses depending on the age when first vaccinated.

The initial recommendations of the ACIP in

February 2000 were that children aged 24 to 59

months with certain underlying medical conditions

or with an immunocompromised state be given PCV7.

ACIP also recommended considering vaccination

with PCV7 for all other children aged 24 to 59

months, with priority given to children who are

American Indian/Alaska Native or of

African-American descent, as well as to children

who attend group daycare centers.

The February 2000 recommendation also indicated

schedules for administering PCV7 to children aged

24 to 59 months who were either unvaccinated or

who had a lapse in PCV7 administration. According

to these schedules, healthy children were to

receive 1 dose of PCV7, whereas children with

certain chronic diseases or immunosuppressive

conditions were to receive 2 doses of PCV7 given at least 2 months apart.

Concern about limited vaccine supply and cost was

the basis underlying ACIP's rationale for

limiting the recommendation for routine

vaccination to children aged 24 to 59 months who

have certain underlying medical conditions or who are immunocompromised.

However, there have been adequate supplies of

PCV7 since September 2004. Furthermore, the

permissive recommendation for healthy children

aged 24 to 59 months was perceived as confusing

by some healthcare providers. Accordingly,

prompted by these considerations, the ACIP

Pneumococcal Vaccines Work Group reviewed

available data on safety and immunogenicity of

PCV7 in children aged 24 to 59 months, current

rates of PCV7-type invasive disease and of

vaccination coverage, and vaccine effectiveness postlicensure.

Based on this review, ACIP approved the following

revised recommendation in October 2007, targeting

use of PCV7 in children aged 24 to 59 months:

* All healthy children aged 24 to 59 months

who have not completed any recommended schedule

for PCV7 should receive 1 dose of PCV7.

* All children aged 24 to 59 months who have

underlying medical conditions and who have

received 3 doses of PCV7 should receive 1 additional dose of PCV7.

* All children aged 24 to 59 months who have

underlying medical conditions and who have

received fewer than 3 doses should receive 2

additional doses of PCV7 given at least 8 weeks

apart, which is the minimum interval between all

doses of PCV7 for children aged 24 to 59 months.

The revised guidelines did not change any

previously published recommendations concerning

the use of PCV7 in children aged 2 to 23 months,

the list of underlying medical or

immunocompromising conditions, or the use of

23-valent pneumococcal polysaccharide vaccine in

children younger than 2 years who have previously received PCV7.

The previously published list of underlying

medical or immunocompromising conditions includes

sickle cell disease, asplenia, chronic heart or

lung disease, diabetes, cerebrospinal fluid leak,

cochlear implant, or human immunodeficiency virus infection.

MMWR Morb Mortal Wkly Rep. 2008;57:343-344.

Clinical Context

In February 2000, PCV7 (Prevnar) was approved by

the US Food and Drug Administration for use in

infants and young children. Because of concerns

regarding limited vaccine supply and cost, ACIP

initially limited its recommendation for routine

vaccination to children aged 24 to 59 months who

have certain underlying medical conditions or who are immunocompromised.

However, there have been adequate supplies of

PCV7 since September 2004, so ACIP has issued

updated recommendations for use of PCV7 among

children aged 24 to 59 months who are either

unvaccinated or who have a lapse in PCV7 administration.

Study Highlights

* Routine administration of PCV7 is as a

4-dose series, given at ages 2, 4, 6, and 12 to 15 months.

* For children younger than 23 months,

catch-up immunization is recommended, using fewer

doses depending on the age when first vaccinated.

* In February 2000, ACIP recommended that

children aged 24 to 59 months with certain

underlying medical conditions or with an

immunocompromised state be given PCV7.

* In February 2000, ACIP also recommended

considering vaccination with PCV7 for all other

children aged 24 to 59 months, with priority

given to children who are American Indian/Alaska

Native or of African-American descent, and to

children attending group daycare centers.

* The February 2000 recommendation also

indicated schedules for administering PCV7 to

children aged 24 to 59 months who were either

unvaccinated or who had a lapse in PCV7

administration: healthy children were to receive

1 dose of PCV7, and children with certain chronic

diseases or immunosuppressive conditions were to

receive 2 doses of PCV7 given at least 2 months apart.

* After 2004, the ACIP Pneumococcal Vaccines

Work Group reviewed available data on safety and

immunogenicity of PCV7 in children aged 24 to 59

months, current rates of PCV7-type invasive

disease and of vaccination coverage, and vaccine effectiveness postlicensure.

* Based on this review, ACIP approved the

following revised recommendation in October 2007,

targeting use of PCV7 in children aged 24 to 59 months:

* All healthy children aged 24 to 59

months who have not completed any recommended

schedule for PCV7 should receive 1 dose of PCV7.

* All children aged 24 to 59 months who

have underlying medical conditions and who have

received 3 doses of PCV7 should receive 1 additional dose of PCV7.

* All children aged 24 to 59 months who

have underlying medical conditions and who have

received fewer than 3 doses should receive 2

additional doses of PCV7 given at least 8 weeks

apart (the minimum interval between all doses of

PCV7 for children aged 24 to 59 months).

* No previously published recommendations

were changed for the use of PCV7 in children aged

2 to 23 months, the list of underlying medical or

immunocompromising conditions (sickle cell

disease, asplenia, chronic heart or lung disease,

diabetes, cerebrospinal fluid leak, cochlear

implant, or HIV infection), or the use of

23-valent pneumococcal polysaccharide vaccine in

children younger than 2 years who have previously received PCV7.

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Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

Vaccines -

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