How to vaccinate children against pneumococcus?
Pneumococcus is a dreaded pathogen causing serious diseases in pediatric patients. However, it can be effectively prevented with commonly available vaccines. Let's look at the updated recommendation of the Czech Vaccinological Society ČLS JEP from April this year.
Pneumococcus and pneumococcal infections
Pneumococcus, or Streptococcus pneumoniae, is one of the most common causes of bacterial diseases in children. It is responsible for a wide range of infections, including the dreaded purulent meningitis. The risk of severe pneumococcal disease depends on the age and presence of comorbidities in young patients.
Pneumococcal infections are divided into invasive, where this bacterium is found in normally sterile locations, and mucosal, where it infects an area it can colonize. Examples of invasive diseases include pneumonia or purulent meningitis, while mucosal infections primarily include otitis media and rhinosinusitis. The incidence of pneumococcal diseases in children is highest in infants and decreases with age.
Types of vaccines and their benefits
There are 2 types of vaccines available on the Czech market. Polysaccharide vaccines, which contain the bacterial capsule polysaccharides themselves, and conjugated vaccines, where these structures are linked to a protein carrier. Each type has its pros and cons:
- Polysaccharide vaccines cover more serotypes, for example, the PPSV23 vaccine is effective against 23 serotypes of Streptococcus pneumoniae.
- Conjugated vaccines (PCV) are more effective in children under two years and immunocompromised patients. They also show higher efficacy in preventing mucosal infections and the acquired immunity persists longer. Vaccines effective against 13, 15, and up to 20 serotypes are available.
Vaccine safety
Post-vaccination issues occur with similar frequency as with other vaccines administered to children. Adolescents may experience post-vaccination syncope.
Vaccination schedules
Considering the serotype coverage, epidemiological situation, and immunological properties of the vaccines, only conjugated vaccines PCV13, PCV15, and PCV20 are recommended for children. PCV15 and PCV20 vaccines are preferred over PCV13.
Vaccination schedule for healthy full-term children
Routine vaccination with a conjugated vaccine is indicated for all children under 5 years. A 2+1 schedule is recommended for PCV15 and PCV13 vaccines. In practice, one dose is applied at 2 and 4 months followed by a booster at 11–13 months of age. The minimum age for the first vaccine dose is 8 weeks. The same minimum interval applies between doses. The administration of the first vaccine at 6 weeks and the second dose at least 4 weeks later with a booster at least at 11 months is also considered valid.
The 3+1 schedule for PCV20 involves administering 3 doses from the age of 2 months at intervals of 4–8 weeks with a booster at 12–15 months (at least at 11 months). The minimum age for the first dose is 8 weeks. The minimum intervals between primary vaccination doses are 4 weeks, and the minimum interval between the third and booster (final) dose is 8 weeks.
Catch-up schedule
If vaccination is not initiated according to the above schedule, it can be performed later with slight modifications. For infants up to 7 months of age, the same intervals as the standard schedule can be followed. When starting vaccination at 7–11 months of age, 2 doses are administered with an interval of 4–8 weeks and a booster at least 8 weeks after the second shot. If vaccinating a toddler aged 12–23 months, 2 doses are given at 8-week intervals. Children aged 2–4 years receive only 1 dose of the vaccine. In healthy children over 5 years old, vaccination is not initiated. At this age, vaccination is only considered for children with defined risk factors (e.g., persistent asthma, diabetes, or immunodeficiencies).
Vaccination of preterm children
Preterm infants who are still hospitalized at 8 weeks of age are recommended to be vaccinated before discharge from the hospital. If this does not happen, vaccination should be carried out as soon as possible after discharge. The vaccination schedule is 3+1 for PCV15 and PCV20.
Vaccination of high-risk groups
Vaccination for immunocompromised children can be delayed by 6 months if an improved response to the vaccine is anticipated. If improvement is not expected, vaccination should not be delayed. A 3+1 schedule with PCV20 is recommended.
The above schedules are in line with the recommendations of the Czech Vaccinological Society ČLS JEP as of April 10, 2024.
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Source: Recommendations of the Czech Vaccinological Society ČLS JEP for the vaccination of children and adolescents aged 0-17 against pneumococcal diseases. ČVS, April 10, 2024. Available at: https://vakcinace.eu/doporuceni-a-stanoviska/doporuceni-ceske-vakcinologicke-spolecnosti-cls-jep-pro-ockovani-deti-a-adolescentu-ve-veku-0-17-let
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