Pneumococcal Conjugate Vaccine
Synonyms :
PCV10, PCV13
Mechanism :
Pneumococcal conjugate vaccine (PCV) helps to prevent against Streptococcus pneumoniae infection. There are currently 2 types of PCV available: PCV10 and PCV13.
Historically PCV7 was the first conjugate pneumococcal vaccine available globally. It was a heptavalent vaccine that was a sterile solution of saccharides of the capsular antigens of Streptococcus pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F individually conjugated to diphtheria CRM197 protein.
Subsequently, more serotypes were added in the vaccine and was named as PCV13. It contains thirteen serotypes of pneumococcus (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F).
PCV10 contains ten serotypes of pneumococcus (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F) which are conjugated to a carrier protein.
Contraindications :
Hypersensitivity to any component of the vaccine, including diphtheria toxoid, is a contraindication to use of this vaccine. Although a severe or even a moderate febrile illness is sufficient reason to postpone vaccinations, minor illnesses, such as a mild upper respiratory infection with or without low-grade fever, are not generally contraindications.
Dosing :
IAP Guidebook on Immunization 2013–14 recommends:
For routine immunization both PCV10 and PCV13 are licensed for children from 6 weeks to 5 years of age (although the exact labelling details may differ by country).
Primary schedule (for both PCV10 and PCV13): 3 primary doses at 6, 10, and 14 weeks with a booster at age 12 through 15 months
Additionally, PCV13 is licensed for the prevention of pneumococcal diseases in adults >50 years of age.
CDC, ACIP Guidelines (North America, Mid East, most Euros’ countries):
PCV13 is recommended for routine immunization for healthy children at 2, 4, 6, and 12 to 15 months of age.
Children who miss their shots at these ages should still get the vaccine. The number of doses and the intervals between doses will depend on the child’s age.
In adults of 50 years and older age group, PCV13 is indicated for active immunization for the prevention of pneumonia and invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F.
For adults 50 years of age and older: PCV13 is to be administered as a single dose, including for those previously vaccinated with a pneumococcal polysaccharide vaccine. The need for re-vaccination with a subsequent dose of PCV13 has not been established.
Adverse Effect :
In paediatric population: Decreased appetite, irritability, drowsiness/increased sleep, restless sleep/decreased sleep, fever, any injection-site erythema, induration/swelling or pain/tenderness. In adult population: The safety of PCV13 was assessed in 6 clinical studies, which included 6,198 adults (5,667 received PCV13) ranging in age from 50 through 95 years. Pain, redness, swelling and limitation of arm movement were observed locally; generalized muscle and joint pains, fatigue, headache, rash, chills, vomiting, decreased appetite, fever have been observed. Across the 6 studies, serious adverse events within 1 month of vaccination were reported after an initial study dose in 0.2%-1.4% of 5055 persons vaccinated with PCV13 and in 0.4%-1.7% of 1124 persons vaccinated after an initial study dose of PPSV23. From 1 month to 6 months after an initial study dose, serious adverse events were reported in 1.2%-5.8% of persons Vaccinated during the studies with PCV13 and in 2.4%-5.5% of persons vaccinated with PPSV23. One case of erythema multiforme occurred 34 days after receipt of a second dose of PCV13. Concomitant administration with TIV may lead to an increase in some non-serious systemic adverse reactions.
Interaction :
PCV13 will only protect against pneumococcal serotypes included in the vaccine and may not protect all individuals receiving the vaccine. Safety and immunogenicity data on PCV13 are not available for immunocompromised individuals (e.g., individuals with splenic dysfunction, HIV infection, malignancy, nephrotic syndrome) and vaccination should be considered on an individual basis. Premature infants may suffer from apnea after primary immunization series. Very premature infants (born <30 weeks of gestation) may require monitoring for at least 48 hours after vaccination.
Hepatic Dose :
No dosage adjustments are recommended.