Data are unclear, however, whether removing a PCV dose at 6 months (2+1) or at 12-15 months (3+0) will help reduce refusals or delays of other recommended vaccines, Dr. Pilishvili said.
Several attendees who were ACIP liaison representatives expressed concern about the interval between PCV13 doses in the various schedules. Dr. Ruth Karron, director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative, Baltimore, was troubled by the 2+1 schedule, observing that if parents delay too long, there is invasive disease that occurs in the 12- to 18-month age range.
"I’m wondering if the data we already have are telling us something about a 2+1 versus a 3+0 schedule," she added.
Dr. Mark Netoskie of America’s Health Insurance Plans, reminded the committee about the "quagmire" that occurred with permissive recommendations for human papillomavirus vaccinations.
"I speak against options 3 and 4 [i.e., permissive recommendations], as it will open a quagmire, and I foresee a potential for scattered coverage across the country," he said. "The data’s either strong enough to recommend it or the data’s not strong enough to recommend it, or it’s strong enough to recommend it or recommend it for certain groups."
Dr. Pilishvili responded, "I appreciate your comment. There were several on the working group who shared your concerns."
Among its conclusions, the working group stated that a three-dose PCV13 schedule for routine use among infants requires careful consideration of implementation issues, and that further discussion is needed to define groups to be excluded from potential policy change and on the potential impact on nonadherence.
Dr. Pilishvili and Ms. Tomczyk reported having no financial disclosures.