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CDC Panel Clarifies Pneumococcal Catch-Up Dosage Guides

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

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ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

ATLANTA — Healthy children between 2 and 5 years of age who have been incompletely vaccinated against pneumococcal disease should receive one dose of 7-valent pneumococcal conjugate vaccine, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its fall meeting.

The panel also voted that children aged 24-59 months with underlying medical conditions who are incompletely vaccinated should receive two doses of 7-valent pneumococcal conjugate vaccine (PCV7) at least 2 months apart, unless they have already received three doses, in which case one dose should be given.

The definition of underlying conditions includes sickle-cell disease or related conditions, splenic dysfunction, HIV infection, immunocompromising conditions, chronic cardiac or pulmonary disease, cerebrospinal fluid leaks, and diabetes mellitus (MMWR 2000;49[RR-9]:1-38).

"The Work Group feels that simplifying and expanding the catch-up recommendation may improve PCV7 coverage among healthy, unvaccinated or incompletely vaccinated children aged 24-59 months, including immigrants and adoptees," said Dr. Pekka Nuorti of the CDC.

The catch-up recommendations could apply to a significant proportion of children, given that 32% of children aged 2-5 years have received fewer than four doses of PCV7, according to 2006 National Immunization Survey data. However, the majority of children (87%) have received at least three doses of the vaccine.

The ACIP vote passed 11-3, with panel members raising several concerns. Some questioned the extent of disease prevention that the change would provide and the cost-effectiveness of the recommendation. No formal cost-effectiveness analysis has been done, and panel members explained that the aim was just to clarify the existing recommendations. ACIP plans to revise its statement on pneumococcal diseases this year.

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