How Is Prevnar 13 Given
Prevnar 13 is given as an injection into a muscle.
For infants and toddlers, the pneumococcal 13-valent vaccine is given in a series of shots. The first shot is usually given when the child is 6 weeks to 2 months old. The booster shots are then given at 4 months, 6 months, and 12 to 15 months of age.
If your child is 7 months to 5 years old, he or she can still receive Prevnar 13 on the following schedule:
Age 7-11 months: Two shots at least 4 weeks apart, followed by a third shot after the child turns 1 year .
Age 12-23 months: Two shots at least 2 months apart.
Age 24 months to 5 years : One shot.
The timing of this vaccination is very important for it to be effective. Your child’s individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by your local health department.
For adults and children older than 5 years, Prevnar 13 is usually given as one shot.
Be sure to keep your child on a regular schedule for other immunizations such as diphtheria, tetanus, pertussis , hepatitis, and varicella . Your doctor or state health department can provide you with a recommended immunization schedule.
Does Pneumovax 23 Cause Side Effects
Pneumovax 23 is an immunization used to prevent pneumonia. This pneumococcal vaccine contains chemicals extracted from 23 types of Streptococcuspneumonia bacteria.
Upon injecting pneumococcal vaccine, the body recognizes these chemical as foreign and produces antibodies to destroy the chemicals. Antibodies are blood protein that help the body fight infection and destroy other harmful substances.
Once produced, these antibodies destroy injected Streptococcuspneumonia chemicals but the antibodies remain active in the body and can detect the same chemicals from live Streptococcus pneumonia in the future. If a vaccinated person comes in contact with Streptococcus pneumonia the antibodies will destroy the bacteria and prevent pneumonia or reduce its severity.
Pneumovax 23 should not be confused with pneumococcal conjugate vaccine used in special conditions because often in the medical literature the non-specific term “pneumococcal vaccine” is used.
Common side effects of Pneumovax 23 include
- injection site reactions ,
Serious side effects of Pneumovax 23 include severe allergic reactions.
Drug interactions of Pneumovax 23 include zoster vaccine live administered at the same time. When they are given concurrently, Pneumovax 23 reduces the response of zoster vaccine compared to those who received both vaccines 4 weeks apart.
Children At High Risk Of Ipd
Infants at high risk of IPD due to an underlying medical condition should receive Pneu-C-13 vaccine in a 4 dose schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. Table 3 summarizes the recommended schedules for Pneu-C-13 vaccine for infants and children at high risk of IPD due to an underlying medical condition by pneumococcal conjugate vaccination history.
In addition to Pneu-C-13 vaccine, children at high risk of IPD due to an underlying medical condition should receive 1 dose of Pneu-P-23 vaccine at 24 months of age, at least 8 weeks after Pneu-C-13 vaccine. If an older child or adolescent at high risk of IPD due to an underlying medical condition has not previously received Pneu-P-23 vaccine, 1 dose of Pneu-P-23 vaccine should be administered, at least 8 weeks after Pneu-C-13 vaccine. Children and adolescents at highest risk of IPD should receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization. Refer to Immunocompromised persons for information about immunization of HSCT recipients.
Table 3: Recommended Schedules for Pneu-C-13 Vaccine for Children 2 months to less than 18 years of age, by Pneumococcal Conjugate Vaccination History
|Age at presentation for immunization||Number of doses of Pneu-C-7, Pneu-C-10 or Pneu-C-13 previously received|
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Before Taking This Medicine
You should not receive Prevnar 13 if you ever had a severe allergic reaction to a pneumococcal or diphtheria toxoid vaccine.
Tell the vaccination provider if you or the child has:
a bleeding or blood clotting disorder such as hemophilia or easy bruising or
a weak immune system .
Before your child receives Prevnar 13, tell your doctor if the child was born prematurely.
You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving Prevnar 13.
Tell the vaccination provider if you are pregnant or breastfeeding.
Summary Of The Issues
Pneumonia infection is a significant cause of morbidity and mortalityworldwide, and Streptococcus pneumoniae is currently the most commonly identifiedpathogen in community-acquired pneumonia. In the United States, S. pneumoniae is responsible for500,000 cases of pneumonia and 50,000 cases of bacteremia each year with an annualmortality rate of 57% and 20%, respectively. Pneumococcal disease in all of itsforms is estimated to cause 1.6 million deaths globally per year. In addition to the public healthconcerns, pneumonia also accounts for a significant cost to the health caresystem.
Currently there are two leading vaccines targeted against S. pneumoniae:23-valent pneumococcal polysaccharide vaccine and 13-valent pneumococcalconjugate vaccine . Pneumococci bacteria are contained within apolysaccharide capsule. The capsules contain antigenic variation, and over 90distinct capsular serotypes have been identified. PPSV23 contains antigens from 23common serotypes, while PCV13 contains antigens from 13 serotypes. Although both vaccines aim to induceimmunity against the most common serotypes to cause clinical disease, there issubstantial overlap in the antigens contained within each vaccine. Twelve of thethirteen serotypes included in PCV13 are common to PPSV23.
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Are Prevnar 13 And Pneumovax 23 The Same
Not quite. They both protect against pneumococcal bacteria. Prevnar 13 protects against 13 types of bacteria, and Pneumovax 23 protects against 23 types of bacteria. Prevnar 13 is given in the muscle , while Pneumovax 23 can be given either in the muscle or under the skin . Most adults over 65 will receive one dose of each vaccine, one year apart.
Medical Conditions Resulting In High Risk Of Ipd
Table 1: Medical Conditions Resulting in High risk of IPD
IPD is more common in the winter and spring in temperate climates.
Spectrum of clinical illness
Although asymptomatic upper respiratory tract colonization is common, infection with S. pneumoniae may result in severe disease. IPD is a severe form of infection that occurs when S. pneumoniae invades normally sterile sites, such as the bloodstream or central nervous system. Bacteremia and meningitis are the most common manifestations of IPD in children 2 years of age and younger. Bacteremic pneumococcal pneumonia is the most common presentation among adults and is a common complication following influenza. The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons. Bacterial spread within the respiratory tract may result in AOM, sinusitis or recurrent bronchitis.
Worldwide, pneumococcal disease is a major cause of morbidity and mortality. The World Health Organization estimates that almost 500,000 deaths among children aged less than 5 years are attributable to pneumococcal disease each year. In Canada, IPD is most common among the very young and adults over 65 years of age.
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Extended Pneumococcal Immunisation For High
As part of the extended immunisation programme for high-risk groups, PCV13 and 23PPV are funded for eligible individuals, as shown in Table 16.3, Table 16.4 and Table 16.5. Because the recommended schedule depends on the age of the individual at diagnosis, the tables have been organised into age groups .
The PCV13 and 23PPV funding restrictions are as follows. See Table 16.3, Table 16.4 and Table 16.5 for the eligible conditions and dosing requirements.
All high-risk infants are recommended to receive at least three doses of a PCV vaccine, with at least one dose after 12 months of age. Change from PCV10 to PCV13 as soon as the infant is diagnosed as being at high risk.
- Two doses of PCV13 are funded for high-risk children aged from 12 months and under 18 years who have previously received two or three doses of PCV10.
- Up to four doses of PCV13 are funded for vaccination or re-vaccination of high-risk children aged under 5 years.
- Up to four doses of PCV13 are funded for vaccination or re-vaccination of eligible individuals aged 5 years and older.
1 dose of PCV13.b
Give a maximum of 3 doses of 23PPV in a lifetime, a minimum of 5 years apart. The first 23PPV dose is given at least 8 weeks after PCV13, the 2nd a minimum of 5 years later, and the 3rd dose at age 65 years.
Common And Local Adverse Events
Pneumococcal conjugate vaccine
Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38Â°C occurring in approximately 3% of vaccine recipients.
Pneumococcal polysaccharide vaccine
Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.
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Age Recommendations And Dosing
Prevnar 13 is approved for use in children 6 weeks and older, and the CDC recommends it for children younger than 2 years old and people 2 years or older with certain medical conditions. Its given into the muscle, and its a 4-dose series for children between 2 and 15 months of age. For children who dont receive the vaccine at this time, a catch-up schedule is available.
Prevnar 20 is currently approved for use in adults at least 18 years old, but official CDC recommendations havent been established yet. Its given as a single-dose injection into the muscle.
Pneumovax 23 is approved for use in children 2 years and older at higher risk of infection and adults at least 50 years old. However, the CDC recommends it for all adults 65 years or older, people 2 through 64 years with certain medical conditions, and adults 19 through 64 years who smoke cigarettes. Its a single-dose injection given into the muscle or skin, but additional doses may be recommended for some people.
What Is Pneumococcal Disease
Pneumococcal disease is an infection caused by the bacteria Streptococcus pneumoniae. This bacteria commonly shortened to pneumococcus is a common cause of pneumonia and other invasive diseases. An invasive disease is when a germ is in a part of the body thats usually germ-free.
Pneumonia is a lung infection that can affect people of all ages. Although pneumonia can be caused by bacteria, viruses, or fungi, pneumococcus is the most common bacterial cause of pneumonia.
Meningitis a serious infection that surrounds the brain and spinal cord can be caused by a variety of germs, including pneumococcus. Pneumococcus can also cause blood infections , sinus infections, and ear infections.
Pneumococcal vaccines are available to help protect against pneumococcal disease. More on this below.
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Patients In Health Care Institutions
Residents of long-term care facilities should receive Pneu-P-23 vaccine. Refer to Recommendations for Use for information about pneumococcal vaccination of individuals at increased risk of IPD. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional information about vaccination of patients in health care institutions.
What If It Is Not Clear What A Person’s Vaccination History Is
When indicated, vaccines should be administered to patients with unknown vaccination status. All residents of nursing homes and other long-term care facilities should have their vaccination status assessed and documented.
How long must a person wait to receive other vaccinations?
Inactivated influenza vaccine and tetanusvaccines may be given at the same time as or at any time before or after a dose of pneumococcus vaccine. There are no requirements to wait between the doses of these or any other inactivated vaccines.
Vaccination of children recommended
In July 2000, the American Academy of Pediatrics and the CDC jointly recommended childhood pneumococcal immunization, since pneumococcal infections are the most common invasive bacterial infections in children in the United States.
“The pneumococcal conjugate vaccine, PCV13 or Prevnar 13, is currently recommended for all children younger than 5 years of age, all adults 65 years or older, and persons 6 through 64 years of age with certain medical conditions,” according to the 2014 AAP/CDC guidelines. “Pneumovax is a 23-valent pneumococcal polysaccharide vaccine that is currently recommended for use in all adults 65 years of age or older and for persons who are 2 years and older and at high risk for pneumococcal disease . PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma.”
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Conditions Treated By Prevnar 13 And Pneumovax 23
Prevnar 13 is indicated for:
Children six weeks through five years old :
- Active immunization to prevent invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F
- Active immunization to prevent otitis media caused by S. pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F
Children 6 to 17 years old :
- Active immunization to prevent invasive disease caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F
Adults 18 years and older:
- Active immunization to prevent pneumonia and invasive disease caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F
Pneumovax 23 is indicated for active immunization for the prevention of invasive pneumococcal disease that is caused by the 23 serotypes contained in the vaccine . It is approved for use in patients ages 50 years or older, and patients 2 years old who are at increased risk for pneumococcal disease.
Summary Of Information Contained In This Naci Statement
The following highlights key information for immunization providers. Please refer to the remainder of the Statement for details.
Streptococcus pneumoniae is a bacterium that can cause many types of diseases including invasive pneumococcal disease , and community-acquired pneumonia .
For the prevention of diseases caused by S. pneumoniae in adults, two types of vaccines are available in Canada: pneumococcal 23-valent polysaccharide vaccine containing 23 pneumococcal serotypes and pneumococcal 13-valent conjugate vaccine containing 13 pneumococcal serotypes.
NACI has been tasked with providing a recommendation from a public health perspective on the use of pneumococcal vaccines in adults who are 65 years of age and older, following the implementation of routine childhood pneumococcal vaccine programs in Canada.
Information in this statement is intended for provinces and territories making decisions for publicly funded, routine, immunization programs for adults who are 65 years of age and older without risk factors increasing their risk of IPD. These recommendations supplement the recent NACI recommendations on this topic that were issued for individual-level decision making in 2016.
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How Much Will It Cost
At this time, Prevnar 20s list price hasnt been announced. However, this vaccine will likely be common for older adults, and its expected that Medicare will cover the bill. Pneumococcal vaccines are a cost-free benefit of Medicare Part B, and people with original Medicare or Medicare Advantage can receive covered pneumococcal vaccines with specific providers.
If you have Medicaid, check with your state Medicaid agency to see which vaccines are offered. Many Medicaid plans pay for some vaccines, but specific coverage varies.
All Health Insurance Marketplace plans and many private plans cover pneumococcal vaccines when provided by an in-network provider, but costs can vary depending on the specific insurance plan.
For people without insurance or adequate coverage, financial assistance and coupon programs may be available. Check back with GoodRx to find more ways to save and make your vaccinations more affordable.
Summary Of The Evidence
A 2013 study examined the safety and effectiveness of PCV13 in elderly adultswho had previously received vaccination with PPSV23. In this study,anti-pneumococcal opsonophagocytic activity titers were measured to evaluatevaccine efficacy. The study was a randomized, modified double-blinded trialincluding 936 adults aged 70 years and older who had been previously vaccinated withPPSV23 at least 5 years prior to the trial. Study participants were divided into two groups. One groupreceived a second dose of PPSV23, while the other received PCV13. Both groupsreceived a dose of PCV13 1 year later. OPA titers were measured prior to and at 1month following each vaccine administration. Safety assessments were also performedat 2 weeks, 1 month and 6 months post-vaccination status.
This study highlights the limitations of PPSV23 alone in prevention ofpneumococcal disease in the elderly population. However, it is limited by the factthat Wyeth Vaccines Research funded the study. Wyeth Pharmaceuticals, Inc. is themanufacturer of Prevnar 13®. Additionally, while OPA titers are considered ameasurement of functional immune response, it is difficult to extrapolate this datainto prevention of clinical illness. The primary concern for health care providersis a vaccination strategy that will reduce morbidity and mortality in their patientpopulation.
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