Updated Recommendation from the Advisory Committee on
Immunization Practices (ACIP) for Use of 7-Valent Pneumococcal Conjugate
Vaccine (PCV7) in Children Aged 24--59 Months Who Are Not
Completely Vaccinated
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.* 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. At that time, the Advisory Committee
on Immunization Practices (ACIP) recommended that children aged 24--59 months who have certain underlying
medical conditions or are immunocompromised receive PCV7. In addition, ACIP recommended that PCV7 be considered for
all other children aged 24--59 months, with priority given to those who are American Indian/Alaska Native or of
African-American descent, and to children who attend group day care centers
(1). The recommendation also provided
schedules for administering PCV7 to children aged 24--59 months who were either unvaccinated or who had a lapse in
PCV7 administration; these schedules included 1) 1 dose of PCV7 for healthy children, and 2)
2 doses of PCV7 >2 months apart for children with certain chronic diseases or immunosuppressive conditions
(1).
ACIP's rationale for limiting the recommendation for routine vaccination to children aged 24--59 months who
have certain underlying medical conditions or are immunocompromised was concern about limited vaccine supply and
cost. Since September 2004, PCV7 has not been in short supply
(2). Additionally, certain health-care providers have
found the permissive recommendation for healthy children aged 24--59 months to be confusing. The ACIP
Pneumococcal Vaccines Work Group reviewed data on safety and immunogenicity of PCV7 in children aged 24--59 months,
current
rates of PCV7-type invasive disease, vaccination coverage rates, and post-licensure vaccine effectiveness. In October
2007, on the basis of that review, ACIP approved the following revised recommendation for use of PCV7 in children aged
24--59 months†:
For all healthy children aged 24--59 months who have not completed any recommended schedule for
PCV7, administer 1 dose of PCV7.
For all children with underlying medical conditions aged 24--59 months who have received 3 doses,
administer 1 dose of PCV7.
For all children with underlying medical conditions aged 24--59 months who have received <3 doses, administer
2 doses of PCV7 at least 8 weeks apart.
No changes were made to previously published recommendations regarding 1) the use of PCV7 in children aged
2--23 months, 2) the list of underlying medical or immunocompromising conditions, or 3) the use of
23-valent pneumococcal polysaccharide vaccine in children aged
>2 years who have previously received PCV7
(3).
* PCV7 is recommended for routine administration as a 4-dose series for infants at ages 2, 4, 6, and 12--15 months. Catch-up immunization is recommended
for children aged <23 months, using fewer doses depending on age at the time of first vaccination.
† The minimum interval between all doses of PCV7 for children aged 24--59 months is 8 weeks.
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