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The pneumococcus is a bacteria that causes serious infections in adults and children, including pneumonia, blood infections, and meningitis. This bacteria is also the number one cause of sinusitis and ear infections. The 23-valent pneumococcal polysaccharide vaccine (23PS) protects against many different types of the pneumococcus bacteria and it is recommended that to be given to people over age 65 and children over age two who are at high risk.
Unfortunately, 23PS does not provide protection for children under age two, but a newer version of the vaccine, Prevnar, or heptavalent pneumococcal conjugate vaccine (PCV7), is available and can be given to younger children. It was approved by the FDA in February 2000. Prevnar protects against the seven most common strains of Pneumococcus that cause invasive disease, including bloodstream infections and meningitis.
This new immunization may also reduce the number of ear infections a child has in children with a history of recurrent ear infections, but it is not yet approved by the FDA for this indication. It is estimated that children with recurrent ear infections who are vaccinated will have about a 10-20% lower chance of having recurrent ear infections or tube placement.
Remember that Prevnar is not an ear infection vaccine.
Prevnar is given as a four dose series, starting at two months of age (with a minimum of 6 weeks of age). Subsequent doses are given at age four months and six months of age, with a fourth dose at age 12-15 months (and at least two months after the third dose). It is recommended that all children under age 23 months be given this vaccine.
The American Academy of Pediatrics released their recommendations for the prevention of pneumococcal infections with pneumococcal vaccines on June 5, 2000. The AAP recommends the routine use of Prevnar for all children 23 months and younger, and for children aged 24 to 59 months who are at high risk, including children with an immune deficiency, sickle cell disease, asplenia (children without a working spleen), HIV infection, chronic cardiac conditions, chronic lung problems (including asthma), cerebrospinal fluid leaks, chronic renal insufficiency (including nephrotic syndrome) , diabetes mellitus, and children who are receiving immunosuppresive therapy (organ transplants, etc.). The AAP does not recommend routine use in children who are only at moderate risk of infection, including all children aged 24-35 months old, and children aged 36-59 months who attend daycare or who are of Native American, Alaskan native, or African American descent.
Children aged 24-59 months who have already received a dose of 23PS and who are at high risk should also receive 2 doses of Prevnar at least 6-8 weeks later and a second dose of 23PS in 3-5 years. High risk children who have completed the Prevnar series should also receive a dose of 23PS at 24 months of age.
Although not recommended routinely, all children aged 24-59 months may receive one dose of either the 23PS or Prevnar vaccine if desired.
Although it is approved for use up to age 9, it is recommended that Prevnar not be routinely given to children over 5 years old. The risk of invasive infection with the pneumococcus bacteria is much less in children over age 5. However, if desired, high risk children can receive either the older 23PS vaccine, which is cheaper, provides good coverage against 23 subtypes of the pneumococcus and produces a good antibody response in children of this age, or they can receive the newer vaccine.
Because of recent shortages of Prevnar, it is recommend that children only receive 3 doses and that the 4th dose be deferred for healthy children. The full, 4-dose series should continue to be administered to children at increased risk for pneumococcal disease. And any children who missed any doses of Prevnar can be caught up. See our Prevnar Catch-up Schedule for more information.
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One of the biggest controversies surrounding Prevnar has been it's cost. It is one of the most expensive vaccines currently being given, although many insurance carriers are providing coverage for it. If your child isn't under 23 months of age or isn't in one of the high risk groups mentioned above, then your insurance may not cover it. To make sure that your insurance does cover its cost, you should contact your insurance company and verify your benefits, specifically asking about Prevnar coverage, before your next doctor's visit.
Recommended dosing schedule for Prevnar*:
| Age 1st Dose |
Primary Series |
Booster Dose |
| 2-6 months |
3 doses, 8wks apart |
12-15 months |
| 7-11 months |
2 doses, 8wks apart |
12-15 months |
| 12-23 months |
2 doses, 8wks apart |
none |
| 24-59 months |
1 dose |
if high risk** |
*see the modified schedule described above if your child is not high risk until the shortages are resolved.
**high risk children aged 24-59 months should receive a booster dose of Prevnar 6-8 weeks after their first dose. They should also receive one dose of 23PS 6-8 weeks later, and another dose of 23PS in 3-5 years.
The most common adverse effects of Prevnar include injection site reactions, fever (>38ºC/100.4ºF), irritability, drowsiness, restless sleep, decreased appetite, vomiting, diarrhea, and rash or hives.
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