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The Informed Parent

A New Vaccine for Young Children

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jun. 05, 2000
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Mrs. Jones is such a very precise woman that I was not surprised to see her notebook and list of questions when she brought her four-month-old daughter in for her well check. Things couldn't have been going any better for little Ashleigh as her growth, development and exam were perfectly normal. Mom, herself, was amazed that she didn't have any questions.

She then flipped open the notebook to a page that was titled IMMUNIZATIONS. "Lets see," she said in a very business-like manner. "I believe that Ashleigh is due to get a DPT, polio, and Hib vaccine today. Isn't that so?" My response caught her by surprise as evidenced by the long pause that followed. She gathered her composure and listened intently as I discussed a new vaccine with her that is to be given to infants along with the routine immunizations. This vaccine is Prevnar which is to protect against Streptococcus pneumonia (Strep pneumo).

Strep pneumo is a bacteria that is the most common cause of serious life threatening illnesses in children, such as meningitis, bacteremia (bacteria in the blood stream) and pneumonia. It also accounts for around 20-40% of all ear infections in children as well as sinus infections. Over the past decade, resistance of Strep pneumo to the standard and reliable antibiotics which used to treat it has become a serious and concerning problem for the medical community.

Prevnar is a "conjugate" vaccine, meaning that it is attached to a specific diphtheria protein (non-toxic) which greatly enhances the response by the child's immune system to the vaccine as well as improve the duration of protection it affords. Strep pneumo has around 90 different serotypes, or strains, of which Prevnar contains seven. But these seven account for around 80-90% of all diseases in children.

In the United States, the rate of invasive disease from Strep pneumo is highest in infants 6-11 months of age, and remains quite high through the second year of life. Certain groups that are at particular high risk for Strep pneumo are African-American, native American and Alaskan children (2-6 times higher than other children), and children with Sickle cell disease and HIV (25-50 times higher). Prevnar has been studied extensively, and all indications show that it is very effective.

A large study was conducted at Kaiser-Permenante in northern California which involved 37,868 infants and children. Half of the children received Prevnar, and the other half received a different vaccine (the control group). When the study was concluded, there were 40 cases of invasive Strep pneumo reported in the 37,868 children — ONE in the Prevnar group, and 39 in the control group. This is quite an impressive result. As for preventing ear infections, the results were not as dramatic, but this was not unexpected. Strep pneumo accounts for 20-40% of ear infections in children — this also means that 60-80% come from another source. The study done at Kaiser showed that in the Prevnar group, the incidence of otitis media was decreased by 9% which is a modest number. When they looked at the children who had a history of chronic ear infections, the incidence had been reduced by 23 %. In this group the need for ear tubes dropped by 20%.

The Prevnar vaccine was licensed by the FDA in February of this year and the Advisory Committee on Immunization Practices (ACIP) has recommended that it be given to all infants and older children who are at risk, as has the Center for Disease Control. Their recommendations are as follows:

Age at First Dose Primary Series Booster Dose

2-6 months

7-11 months

12-23 months

2-5 years

 

3 doses, 8 weeks apart

2 doses, 8 weeks apart

2 doses, 8 weeks apart

1 dose

 

1 dose at 12-15 months

dose at 12-15 months

None

None

 

Prevnar has been shown to be a safe vaccine and can be given at the same time as the other routine vaccines. Side effects include fever (rarely higher than 39.8 degrees C), fussiness, drowsiness, restless sleep, decreased appetite and redness at the injection site. The frequency and severity of these reactions was similar to those seen with the routine vaccinations.

I was apprehensive about how receptive Mrs. Jones would be to Ashleigh receiving a brand new vaccine, especially after just hearing about it for the very first time...and it was just licensed one month previously. After I presented her with all of the information that I had on the vaccine, and I went over the facts in detail, I put my pen down and sat back in my chair. "I’d be glad to answer any questions you have," I said, waiting to be deluged with legitimate concerns and questions. To my surprise, she had a content and comfortable look on her face. She motioned to me as if to say, "Hold that thought", as she was writing hurriedly in her notebook. When she finished, she put the cap on her pen and shut the notebook. "I just wanted to get down all the information for my husband. I have no questions whatsoever. Let’s go for it!"




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