Prevnar
By Vincent Iannelli, MD

I have heard recently that there is a new vaccine available called Prevnar. What illness does the Prevnar vaccine protect against? Should all children receive this vaccine? What are the benefits? Are there any side effects?  

--Joan Dickson, Miami, Florida

Prevnar is a new vaccine that protects against infection from pneumococcus bacteria. This bacteria causes serious infections in adults and children, including pneumonia, blood infections, and meningitis. It is also the number one cause of sinusitis and ear infections.
 
Although there has been a pneumococcal vaccine (Pneumovax) available for sometime to protect against many different types of pneumococcus bacteria, this vaccine is recommended only for individuals over age 65 and children over age two who are at high risk.

Prevnar, on the other hand, can safely be given to young children. Prevnar was approved by the FDA in February 2000 and 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 especially in children with a history of recurrent ear infections. Although Prevnar has not yet been approved by the FDA for this use, it is estimated that children with recurrent ear infections who are vaccinated will have about a 10-20 percent lower chance of having recurrent ear infections or tube placement.

Prevnar is given as a four dose series, starting at two months of age (with a minimum of six weeks of age). Subsequent doses are given at age four months and six months, with a fourth dose given between 12-15 months of age (and at least two months after the third dose). It is recommended that all children under the age of 23 months be given this vaccine.

The American Academy of Pediatrics released their recommendations for the prevention of pneumoccal 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, and children aged 36-59 months who attend daycare or who are of Native American, Alaskan native, or African American descent. Again, the AAP recommends the routine use of Prevnar for all children 23 months and younger.
 
Although it is approved for use up to age nine, it is recommended that Prevnar not be routinely given to children over five years old. The risk of invasive infection with the pneumococcus bacteria is much less in children over age five.
 
One of the biggest controversies surrounding Prevnar has been its 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 company may not cover it. To make sure that 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.
 
The most common adverse effects of Prevnar include injection site reactions, fever, irritability, drowsiness, restless sleep, and decreased appetite.

Vincent Iannelli, MD, is a board certified pediatrician and webmaster of www.keepkidshealthy.com, a website that offers pediatric parenting advice. He is a member of the Dallas County Medical Society, Texas Medical Association, and is a Fellow of the American Academy of Pediatrics. In addition to having a pediatrics practice in a suburb of Dallas, he is currently an associate professor of pediatrics at the UT Southwestern Medical School.