Pneumococcal vaccine Flashcards
At what age do infants get PCV 13 vaccine?
2 months, 4 months, then boost at 12 months.
if missed, then give vaccine and boost at first birthday, allowing interval of two months between the two vaccines.
Which are the only 2 groups which gets PPV23 boosters every 5 years?
- Asplenic/splenic dysfunction
- chronic renal disease (nephrotic syndrome, or CKD stage 4/5/dialysis/renal transplant)
Testing of antibodies prior to vaccination not required.
Individual above age 65 gets PPV23. otherwise fit. do they need booster?
No.
Person with asthma, severe but not needing repeated/regular steroids. do they need PPV23?
No.
PPV23 only if asthma severe enough to need continuous/repeated steroids.
Give PPV23 for other resp conditions (COPD, CF, bronchiecstasis, ILD, bronchopulmonary dysplasia, pneumoconiosis)
Patient with hypertension, no cardiac complications. Need PPV23?
No
PPV 23 only for hypertension with cardiac complications.
Renal transplant patient. do they need PPV23?
Yes
PPV23 for CKD stage 4/5, or nephrotic syndrome/dialysis/renal transplant.
Patient with CSF shunt. do they need PPV23?
Yes. all CSF leak patients (including CSF shunt) need PPV23.
Diet-controlled diabetes. do they need PPV 23?
No.
PPV 23 only for diabetes on oral hypoglycaemics/insulin.
Patient with cochlear implant. Do they need PPV23?
Yes. but vaccination shouldn’t delay cochlear implant.
patient with chronic liver disease. Do they need PPV23?
Yes, one-off dose.
No need for booster.
What counts as ‘immunosuppressed’ to merit PPV23 vaccine?
- chemo leading to immunosuppression
- bone marrow transplant
- HIV at any stage
- asplenia/splenic dysfunction
- multiple myeloma/genetic disorder affecting immune system (IRAK-4, complement deficiency, NEMO)
- systemic steroids >1month (dose equivalent to pred min 20mg/day or for kids<20kg, 1mg/kg/day)
myeloma patient. do they need PPV23?
Yes coz immunosuppressed.
Kids with at risk conditions from birth to two years of age.
how to manage?
give usual PCV13 doses at 2 months, 4 months and boost at 12 months.
PLUS
give 2nd PCV13 booster at least two months after routine PCV13 booster on first birthday.
+ give single PPV23 booster at age 2 years (min 2 months since last dose PCV13)
Kid diagnosed with at risk condition between age 2 years to 10 years. Had routine PCV13 doses.
Give additional 2nd PCV13 booster dose. two months later, give single dose PPV23 vaccine.
If PPV23 has been given first, wait 6 months before giving PCV13.
Children >10 years old and adults diagnosed with at risk conditions.
How to manage?
regardless of prior PCV13 vaccination, give stat PPV23 vaccine. no additional PPV23 is recommended when reach age 65.
the only exception to above is older children and adults who are SEVERELY IMMUNOCOMPROMISED (multiple myeloma, complement deficiency, bone marrow transplant, acute/chronic leukaemia). they need PCV13, and 2 months later PPV23. If PPV23 given first, wait, 6 months before giving PCV13.
