Recommendations for public health programs on the use of pneumococcal vaccines in children, including the use of 15-valent and 20-valent conjugate vaccines

What

The bacterium Streptococcus pneumoniae can lead to invasive pneumococcal disease (IPD), a serious communicable disease, and other infections such as community acquired pneumonia and acute otitis media. There are currently more than 100 known serotypes of S. pneumoniae. The majority of pneumococcal infections are caused by only a portion of these serotypes.

Health Canada has recently authorized two new pneumococcal conjugate (Pneu-C) vaccines for infants, children and adolescents 6 weeks through 17 years of age:

• Pneu-C-15 (15-valent) is authorized with an indication for prevention of IPD caused by 15 serotypes of S. pneumoniae.
• Pneu-C-20 (20-valent) is authorized with an indication for prevention of IPD caused by 20 serotypes of S. pneumoniae.

Who

IPD is most common in young children, older adults, and groups at increased risk due to a medical condition and/or environmental/living conditions (see Table 1). NACI continues to recommend that all routine infant immunization programs in Canada include a conjugate pneumococcal vaccine.

For routine immunization programs in children less than 5 years of age who are not at increased risk of IPD:

• NACI recommends that either Pneu-C-15 or Pneu-C-20 should be the current product of choice for children less than five years of age in routine immunization programs.

For children at increased risk of IPD due to a medical and/or environmental/living conditions (Table 1):

• NACI recommends that Pneu-C-20 should be used for children 2 months to less than 18 years of age who have conditions that result in increased risk of IPD. Children who have started their pneumococcal vaccine series with Pneu-C-13 or Pneu-C-15 should complete their series with Pneu-C-20.
• NACI recommends that children under 18 years of age who are at increased risk of IPD due to medical and/or environmental/living conditions and who have completed their recommended immunization schedule with Pneu-C-13 or Pneu-C-15, should receive one catch-up (additional) dose of Pneu-C-20.
• NACI recommends that Pneu-C-20 should be offered to children less than 18 years of age who received a hematopoietic stem cell transplant (HSCT) after consultation with their transplant specialist.

How

Pneu-C-15 and Pneu-C-20 are administered intramuscularly using a single-dose, prefilled syringe. A single dose of Pneu-C-15 and Pneu-C-20 is 0.5ml.

Pneu-C-15 and Pneu-C-20 are provided either using a 3-dose (2+1) schedule at 2 months, 4 months and 12 months of age, or a 4-dose (3+1) schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. For more information on immunization schedules, including for children at increased risk of IPD and by immunization history, refer to the pneumococcal vaccines chapter of the Canadian Immunization Guide and Recommendations (Table 7).

Contraindications for Pneu-C-15 and Pneu-C-20 include hypersensitivity (e.g., anaphylaxis) to the vaccine or any of its components. Pneumococcal vaccines may be administered concurrently with other vaccines, except for a different formulation of pneumococcal vaccine (e.g., do not concurrently administer conjugate and polysaccharide pneumococcal vaccines).

Why

Pneumococcal disease can lead to long-lasting complications and can result in significant morbidity and mortality, especially for young children and other children at increased risk of IPD. The most effective way to prevent these infections is through immunization. Pneu-C-15 and Pneu-C-20 are designed to prevent infection from a larger number of serotypes than previous pneumococcal vaccines.