Pneumococcal vaccines provide immunity against pneumococcal disease, which may manifest as, but is not limited to, otitis media, pneumonia, bacteremia, or meningitis. The prevention of serious pneumococcal disease has become an increasingly important health issue due to the increased number of Streptococcus pneumoniae isolates that are drug resistant. Four different polyvalent pneumococcal vaccines, each containing highly purified capsular polysaccharides from S. pneumoniae, are available: conjugated (13-valent pneumococcal conjugate vaccine [PCV13 or Prevnar 13], 15-valent pneumococcal conjugate vaccine [PCV15 or Vaxneuvance], and 20-valent pneumococcal conjugate vaccine [PCV20 or Prevnar 20]) and non-conjugated (23-valent pneumococcal polysaccharide vaccine [PPSV23 or Pneumovax 23]). The vaccines are designed to protect against the most frequent bacterial serotypes associated with pneumococcal infection; however, unlike Pneumovax 23, the capsular polysaccharides in Prevnar 13, Prevnar 20, and Vaxneuvance are coupled to another antigen (diphtheria CRM197) to induce a more effective T-cell response. Routine vaccination with pneumococcal vaccine is recommended by ACIP for all geriatric patients and pediatric patients up to 5 years of age. Vaccination is also recommended for high-risk adults and pediatric patients 2 years and older with underlying medical conditions. PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20) are approved for use in adults and pediatric patients 6 weeks and older. PPSV23 (Pneumovax 23) is approved for use in adults 50 years of age or older and patients 2 years and older who are at high risk.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
-Inform the patient, parent, guardian, or responsible adult of the benefits and risks of the vaccine. Provide the Vaccine Information Statements from the manufacturer to the recipient or guardian before each immunization. These actions are required by the National Childhood Vaccine Injury Act of 1986.
-Record the manufacturer and lot number of the vaccine; date of administration; and the name, address, and title of the person who administered the vaccine in the recipient's permanent medical record. These actions are required by the National Childhood Vaccine Injury Act of 1986.
Route-Specific Administration
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
-Do not mix with any other vaccine.
-When concomitant administration of other vaccines or immunoglobulin is required, they should be given with different syringes and at different injection sites.
Intramuscular Administration
Preparation
-Use vaccine as supplied; reconstitution is not necessary.
-PCV13 (Prevnar 13) and PCV20 (Prevnar 20): Shake vigorously just prior to administration to obtain a homogenous, white suspension. Do not use the vaccine if it cannot be resuspended.
-PCV15 (Vaxneuvance): Shake vigorously just prior to administration to obtain an opalescent suspension. Do not use the vaccine if it cannot be resuspended.
-PPSV23 (Pneumovax 23): Pneumovax 23 is a clear solution that does not require shaking prior to administration.
Intramuscular Injection
-For vials, use a sterile syringe and needle to withdraw the vaccine from the vial. For prefilled syringes, attach a sterile needle.
-Adults: Inject IM into the deltoid muscle or into the anterolateral thigh muscle.
-Pediatric patients: Inject IM into the anterolateral aspect of the mid-thigh (for infants younger than 1 year) or the deltoid muscle of the upper arm (usually suitable for older children). Do NOT administer in the gluteal muscle or other areas where there may be a major nerve trunk.
Subcutaneous Administration
-Only PPSV23 (Pneumovax 23) is approved for subcutaneous administration.
-Use vaccine as supplied; reconstitution is not necessary. The vaccine is a clear solution.
-Use a sterile syringe and needle to withdraw solution from the vial.
-Inject subcutaneously into the outer aspect of the upper arm. Care should be taken to avoid intradermal injection.
Report all adverse reactions to the Vaccine Adverse Event Reporting System (VAERS), as well as to the manufacturer. The toll-free number for VAERS is 1-800-822-7967. Educate the patient or responsible adult(s) to promptly report any adverse reaction after vaccine administration to a health care provider.
The most frequent adverse reaction of pneumococcal vaccine administration in patients of any age is an injection site reaction, which usually is of minor consequence. Patients may experience pain (greater than 50% to greater than 70%), erythema (10.8% to 70%), mild to moderate swelling (10% to 44.5%), warmth, and tenderness (15.1% to 77.2%) at the injection site. Skin necrosis at the injection site has been reported during postmarketing experience with Pneumovax 23. Fever is a relatively common adverse reaction of pneumococcal vaccination (0.3% to 36.5%), and the incidence of fever associated with the primary childhood series is lower with the first dose compared to fevers associated with the second, third, or fourth dose. The majority of fevers experienced are 39 degrees C (102.2 degrees F) or less; however, fevers greater than 40 degrees C (104 degrees F) have been reported in a small number of children and adults (1% or less). In addition, fatigue (13.2% to 80.5%), chills (2.7% to 38.1%), headache (15.9% to 81.4%), pruritus (0.2% to 1.6%), and malaise have been reported. The other most common adverse reactions in young children include irritability (14.3% to 85.6%), drowsiness (2.6% to 71.5%), and insomnia or restless sleep (6.8% to 47.7%) in the days after vaccination. In clinical trials of infants and children, the vaccine was simultaneously administered with other vaccines, including DTP and Hib immunizations.
While seizures were reported in 8 patients receiving Prevnar in clinical trials, these patients had received concomitant DTP- or DTaP-containing vaccines. Seizures were described in 393 reports to the Vaccine Adverse Event Reporting System. About a third of patients had symptoms within 24 hours and about a fourth of the seizures were defined as febrile seizures. Of the 393 seizure cases, 57 occurred after receipt of only Prevnar. During the 2010 to 2011 influenza season, there were increased reports of febrile seizures in children 6 months to 4 years of age receiving the inactivated influenza vaccine and the conjugated pneumococcal vaccine (Prevnar 13) concomitantly. At this time the CDC is not recommending any changes to the childhood immunization schedule, and based on the benefits of timely vaccination against these diseases, they are also not recommending that the vaccines be separated into multiple healthcare visits. The CDC found that febrile seizures were rare in this group with approximately 1 additional seizure occurring for every 2,000 to 3,000 children vaccinated. Febrile seizures occurred most commonly in children 12 to 23 months of age who received both vaccines at the same healthcare visit. During premarketing clinical trials of Prevnar 13, less than 1% of vaccinees experienced seizures (including febrile seizures).
Pneumococcal vaccination has been associated with relapse of immune thrombocytopenic purpura (ITP) in previously stabilized patients. A report of a patient that developed a platelet count less than 150,000 mm3, immune thrombocytopenic purpura, and aplastic anemia 1 week after her first dose of Prevnar given alone has been received through the Vaccine Adverse Event Reporting System (VAERS). Over the first 2 years after approval of Prevnar, 78 reports of possible thrombocytopenia (e.g., petechiae, purpura, or ecchymosis) were received through VAERS. Most patients developed symptoms 1 to 35 days after immunization. Twelve patients had a documented platelet count less than 20,000 mm3, but at least 8 patients had vaccines, medications, or viral or bacterial infections as potential causes. Ecchymosis occurred in 1.1% of adults after pneumococcal vaccination with Pneumovax 23 in clinical trials. Lymphadenitis, lymphadenopathy, hemolytic anemia, and leukocytosis have also been reported with postmarketing use of pneumococcal vaccine; however, a causal relationship to the vaccine has not been established.
Paresthesias and acute radiculoneuropathy, such as Guillain-Barre syndrome, have occurred after pneumococcal vaccination, but such reactions are rare, and a causal relationship cannot be established.
Over the first 2 years after approval of Prevnar, 6 reports of serum sickness were received through the Vaccine Adverse Event Reporting System. Symptoms occurred within 1 day of vaccination in half of the cases. Of the 6 patients, 5 had only received vaccination with Prevnar. Furthermore, the Prevnar dose was the first for 3 of these patients. Also, Arthus reaction has occurred and is more likely to occur with repeat vaccination. In addition, 26 reports of arthritis or arthralgia have been received. Although these events have not been specifically reported with Prevnar 13, they should still be considered potential reactions because of the similarity of the Prevnar 13 product to Prevnar. Generalized new muscle pain (18.4% to 82%), generalized aggravated muscle pain (9.1% to 55.9%), generalized new joint pain (7.4% to 41.7%), and generalized aggravated pain (5.2% to 28.6%) have all been reported in adult patients after administration of Prevnar 13. Myalgia (11.9% to 61.8%), arthralgia (7.7% to 31.5%), neck pain (0.7% to 1.5%), and back pain (0.9%) have also been reported in clinical trials of pneumococcal vaccine.
Development of a rash appears to be a common adverse effect of vaccination with Prevnar. Over the first 2 years after approval of Prevnar, 796 reports of a rash were received through the Vaccine Adverse Event Reporting System. Of the 796 cases, 183 patients had only received vaccination with Prevnar. Also, there were 39 reports of erythema multiforme of which 9 patients had received vaccination only with Prevnar. During premarketing trials of Prevnar 13, rash occurred in more than 1% of infants and children and 7.3% to 21.3% of adults who received the vaccine. Rash has also been reported with postmarketing use of Pneumovax 23; however, a causal relationship has not been established.
Of 4,154 reports to the Vaccine Adverse Event Reporting System over 2 years, about a third were in regard to allergic reactions (e.g., anaphylactic shock, urticaria, pruritus, facial edema, angioedema, asthma, dyspnea, bronchospasm, anaphylactic or anaphylactoid reactions). Of 14 patients that had anaphylaxis or an anaphylactoid reaction, 12 received only the initial dose of Prevnar; 2 patients received the initial dose without difficulty. All patients survived and at least 8 received epinephrine. Of the 3 patients that received only vaccination with Prevnar, 2 had symptoms emerge within 5 to 30 minutes of vaccination. Symptoms emerged within 1 to 4 hours in the other patient. During premarketing clinical trials of Prevnar 13, less than 1% of vaccinees experienced a hypersensitivity or allergic reaction that included facial edema, dyspnea, bronchospasm, and urticaria. Anaphylactoid reactions, angioedema, and urticaria have also been reported with postmarketing use of Pneumovax 23; however, a causal relationship has not been established.
Anorexia (decreased appetite) occurred in 10.4% to 56.7% of patients receiving the pneumococcal vaccine in clinical trials. Vomiting (0.9% to 15% adults; more than 1% pediatrics), diarrhea (0.7% to 1.1% adults; more than 1% pediatrics), nausea (1.8% adults), and dyspepsia (1.1% adults) have also been reported to occur in patients receiving the pneumococcal vaccine. Intussusception has been reported in 5 patients that received a dose of Prevnar; 1 patient developed the adverse event after receipt of only Prevnar. Importantly, none of the patients had vaccination with rotavirus or oral polio. Symptoms of intussusception occurred within 2 days of vaccination in 4 patients and within 2 weeks in the other patient. One patient died after months of frequent diarrhea.
Over the first 2 years after approval of Prevnar, 144 reports of pallor, syncope, or dizziness were received through the Vaccine Adverse Event Reporting System. However, most patients received a dose of Prevnar in conjunction with another vaccine. Eight patients had a hypotonic, hyporesponsive episode, hypotonia, or hyporesponsiveness after receipt of a Prevnar dose. Forty-one additional patients had one of the events, but they received Prevnar in conjunction with another vaccine. One case of a hypotonic-hyporesponsive episode was reported in the efficacy study after concurrent Prevnar and DTP vaccines. Two additional cases of hypotonic-hyporesponsive episodes were reported in four other studies, and these also occurred in children who received Prevnar concurrently with the DTP vaccine. One (0.015%) hypotonic-hyporesponsive episode was reported with Prevnar 13 from infant and toddler clinical studies.
In clinical trials comparing the two conjugated pneumococcal vaccines (Prevnar and Prevnar 13), the most commonly reported serious adverse effect was infection. Bronchiolitis was reported in 0.9% of children who received Prevnar 13 vs. 1.1% of children who received Prevnar. Gatroenteritis was reported in 0.9% of children who received either conjugated pneumococcal vaccine. Pneumonia was reported in 0.9% of children who received Prevnar 13 and 0.5% of children who received Prevnar. Upper respiratory tract infection (1.8% to 2.6%) and pharyngitis (0.4% to 1.1%) were reported in clinical trials of adults receiving vaccination with Pneumovax 23.
Apnea following intramuscular administration of vaccines has been observed in some infants born prematurely. Consider the medical status of the infant and risks and benefits of immunization with pneumococcal vaccine in this patient population.
Prior to administration, inform the patient, parent, guardian, or responsible adult of the benefits and risks of the vaccine, and provide the Vaccine Information Statement, accessible at the Centers for Disease Control and Prevention (CDC) website. These actions are required by the National Childhood Vaccine Injury Act of 1986. If a dose of pneumococcal vaccine, polyvalent has been previously given, question the parent or guardian about previous adverse reactions that may preclude further administration. Report all adverse reactions to the Vaccine Adverse Event Reporting System (VAERS), as well as the manufacturer. The toll-free number for VAERS is 1-800-822-7967. Educate the responsible adult(s) to promptly report any adverse reaction after vaccine administration to a health care provider.
Pneumococcal vaccines are contraindicated in patients who have had a previous hypersensitivity reaction to the vaccine to be administered or to any components of the vaccine. PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20) are contraindicated in patients who have had a hypersensitivity reaction to any diphtheria toxoid-containing vaccine. As with any biologic product, the prescriber or health care professional should have procedures in place to manage allergic reactions. The health care professional should have immediate availability of epinephrine (1 mg/mL) injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction to the pneumococcal vaccines.
The conjugated pneumococcal vaccines (PCV13 [Prevnar 13], PCV15 [Vaxneuvance], or PCV20 [Prevnar 20]) are only indicated for intramuscular administration; do not give via intravenous administration, subcutaneous administration, or intradermal administration. PPSV23 (Pneumovax 23) may be administered via intramuscular or subcutaneous routes. Incorrect administration may result in inadequate immunity.
The decision to administer or delay vaccination with the pneumococcal vaccine because of current or recent febrile illness depends on the severity of symptoms and on the etiology of the disease. The Advisory Committee on Immunization Practices recommends that vaccinations be delayed during the course of a moderate or severe acute illness with or without fever and administered after the acute phase of illness has resolved. All vaccines can be given to persons with minor illnesses such as diarrhea, mild upper-respiratory infection with or without low-grade fever, or other low-grade febrile illness.
Use pneumococcal vaccines with caution in patients with immune thrombocytopenic purpura (ITP) because pneumococcal vaccination has been associated with relapse of this condition in previously stabilized patients. Monitor patients for relapse after vaccination.
Use pneumococcal vaccines cautiously in patients with severe cardiac disease or pulmonary disease because systemic reactions may pose significant risks in these patient populations. In patients at higher risk for pneumococcal infection, including those with chronic heart or lung disease, diabetes mellitus, cochlear implants, or cerebrospinal fluid leaks (due to congential lesions, skull fractures, or neurosurgical procedures), give the pneumococcal vaccine in accordance with current immunization schedules. Pneumococcal meningitis may not be prevented with pneumococcal immunization in patients with cerebrospinal fluid leaks.
Patients with significant immunosuppression may not have an adequate antibody response to pneumococcal vaccines. Immunosuppressed persons may include those with: absent or deficient splenic function (including sickle cell disease); severe combined immunodeficiency (SCID); hypogammaglobulinemia; agammaglobulinemia; chronic renal failure and nephrotic syndrome; allogeneic stem cell transplant; organ transplant; altered immune states due to generalized neoplastic disease (i.e., leukemia, lymphoma, Hodgkin lymphoma); or an immune system compromised by radiation therapy or drug therapy (e.g., chemotherapy or corticosteroid therapy with greater than physiologic doses). Short-term (less than 2 weeks) corticosteroid therapy or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive. In a study evaluating antibody response to the pneumococcal conjugate vaccine (PCV13) in pediatric patients with sickle cell disease, antipneumococcal opsonophagocytic activity (OPA) geometric mean antibody titers (GMTs) for all vaccine serotypes were higher than prevaccination concentrations after the first dose, and were generally comparable after subsequent doses. In patients (age 2 to 71 years) who received an allogeneic hematopoietic stem cell transplant 3 to 6 months prior to a series of PCV13 vaccines, sera was obtained approximately 1 month after each vaccination. Immune responses (IgG GMCs) were numerically higher after the first dose compared with baseline and were, similarly, numerically higher after each subsequent dose compared to the previous dose. Invasive pneumococcal disease has decreased substantially among pediatric patients with sickle cell disease since the introduction of PCVs; however, risk still remains higher compared to healthy patients. Patients with chronic immunodeficiency should receive PCV13 in addition to PPSV23 (23-valent pneumococcal polysaccharide vaccine) according to current immunization schedules. If elective splenectomy or immunosuppressive therapy is planned, complete necessary pneumococcal immunization at least 2 weeks before surgery or therapy initiation.
Compared to healthy individuals, patients with human immunodeficiency virus (HIV) infection generally have lower vaccine-induced antibody concentrations, which are proportional to the severity of infection (i.e., CD4 counts) and are lowest in those with acquired immunodeficiency syndrome (AIDS). The 13-valent pneumococcal conjugate vaccine (PCV13) may be administered to all persons with HIV, regardless of CD4 counts. In those who receive the PCV13 when the CD4 count is less than 200 cells/mm3, some experts may choose to defer the 23-valent pneumococcal polysaccharide vaccine (PPSV23) until CD4 counts are above 200 cells/mm3 in order to optimize vaccine efficacy. Vaccination is increasingly pertinent with the rising incidence of drug-resistant S. pneumoniae infections. In studies evaluating antibody response to the pneumococcal conjugate vaccine (PCV13) in pediatric patients and adults with HIV infection, antipneumococcal opsonophagocytic activity (OPA) geometric mean antibody titers (GMTs) for all vaccine serotypes were higher than prevaccination concentrations after the first dose, and were generally comparable after subsequent doses. In other studies involving pediatric patients with HIV, antibody response to various formulations of pneumococcal conjugate vaccines (PCV) have been slightly lower but comparable to patients who are not infected.
Safety and efficacy of the pneumococcal conjugate vaccine 13 (PCV13 or Prevnar 13), pneumococcal conjugate vaccine 15 (PCV15 or Vaxneuvance), or pneumococcal conjugate vaccine 20 (PCV20 or Prevnar 20) have not been established in neonates and infants younger than 6 weeks of age. Safety and efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23) have not been established in children younger than 2 years of age. Patients in this age group do not develop an effective immune response to the capsular types contained in this polysaccharide vaccine. Apnea has occurred in some premature neonates and infants after intramuscular injections. The risks and benefits of intramuscular injections, including vaccination with the pneumococcal vaccine, must be considered on an individual patient basis. In addition, health care providers are advised that immunogenicity may be lower in premature neonates. In 1 study, premature neonates (younger than 37 weeks gestation; n = 100) receiving Prevnar 13 on a non-United States 4-dose schedule displayed lower serotype-specific IgG antibody responses after the third and fourth doses when compared to term neonates (37 weeks gestation and older; n = 100).
Available data on pneumococcal vaccine administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy. No adequate and well-controlled studies have been conducted in pregnant women. No fetal malformations were noted after administration of pneumococcal conjugate vaccine 13 (PCV 13) at a dose approximately 20 times the human dose to rabbits prior to mating and during gestation. According to the Advisory Committee on Immunization Practices (ACIP), administration of inactivated vaccines to pregnant women has not resulted in adverse effects in the fetus. The ACIP recommends vaccination during pregnancy when the likelihood of disease exposure is high, potential infection would cause harm to mother or fetus, and when the vaccine is unlikely to cause harm.
Data are limited regarding use of the pneumococcal vaccine during breast-feeding and its excretion in human breast milk is unknown. According to the Advisory Committee on Immunization Practices (ACIP), inactivated vaccines pose no risk for mothers or their infants. Additionally, breast-feeding does not adversely affect immunization; limited data suggest breast-feeding may enhance the immune response to certain vaccine antigens. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
The pneumococcal vaccines are indicated for intramuscular (IM) administration. Therefore, administer with caution to persons receiving anticoagulant therapy. Also, monitor patients with thrombocytopenia, coagulopathy (e.g., hemophilia), other bleeding disorders, or vitamin K deficiency closely for bleeding at the IM injection site. Steps to avoid hematoma formation are recommended.
For pneumococcal prophylaxis:
-for routine immunization:
Intramuscular dosage (PCV13 or Prevnar 13):
Adults 65 years and older: ACIP does not recommend PCV13 for older adults. Vaccination with PCV20 or PCV15 (followed by a dose of PPSV23) is recommended in these patients. The FDA-approved product labeling recommends a single 0.5 mL IM dose.
Adults 18 to 64 years: 0.5 mL IM as a single dose. Vaccination is only recommended for adults with underlying medical conditions.
Children and Adolescents 5 to 17 years at first dose: 0.5 mL IM as a single dose. Vaccination is only recommended in patients with underlying medical conditions.
Children 24 to 59 months at first dose: 0.5 mL IM as a single dose.
Children 12 to 23 months at first dose: 0.5 mL IM for 2 doses administered at least 8 weeks apart.
Infants 7 to 11 months at first dose: 0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 8 weeks.
Infants 6 weeks to 6 months at first dose: 0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 8 weeks after the third dose.
Intramuscular dosage (PCV15 or Vaxneuvance):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.
Adults 65 years and older who previously received PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 18 to 64 years: 0.5 mL IM as a single dose. Recommended for adults with underlying medication conditions.
Children and Adolescents 5 to 17 years at first dose: 0.5 mL IM as a single dose. Recommended in children and adolescents with underlying medication conditions.
Children 24 to 59 months at first dose: 0.5 mL IM as a single dose. Administer a single dose to children who have received an incomplete series of another pneumococcal conjugate vaccine. At least 8 weeks should elapse between receipt of the last dose of another pneumococcal conjugate vaccine and administration of Vaxneuvance.
Children 12 to 23 months at first dose: 0.5 mL IM for 2 doses, separated by at least 8 weeks.
Infants 7 to 11 months at first dose: 0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 8 weeks.
Infants 6 weeks to 6 months at first dose: 0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 8 weeks after the third dose. The 4-dose series initiated with a lower valency pneumococcal conjugate vaccine (i.e., PCV13) can be completed with Vaxneuvance.
Intramuscular dosage (PCV20 or Prevnar 20):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated.
Adults 65 years and older who previously received PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 65 years and older who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Adults 18 to 64 years: 0.5 mL IM as a single dose. Recommended for adults with underlying medication conditions.
Children and Adolescents 15 months to 17 years previously vaccinated with at least 1 dose of a lower valency pneumococcal conjugate vaccine: 0.5 mL IM as a single dose at least 8 weeks after receipt of a lower valency pneumococcal conjugate vaccine.
Children and Adolescents 5 to 17 years at first dose: 0.5 mL IM as a single dose. Recommended in children and adolescents with underlying medication conditions.
Children 24 to 59 months at first dose: 0.5 mL IM as a single dose.
Children 12 to 23 months at first dose: 0.5 mL IM for 2 doses, separated by at least 2 months.
Infants 7 to 11 months at first dose: 0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 2 months.
Infants 6 weeks to 6 months at first dose: 0.5 mL IM for a total of 4 doses. Administer at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 2 months after the third dose.
Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23):
Adults 65 years and older: 0.5 mL IM or subcutaneously as a single dose. If patient previously received a pneumococcal conjugate vaccine (PCV13, PCV15), administer at least 1 year after conjugate vaccine dose.
Adults 50 to 64 years: 0.5 mL IM or subcutaneously as a single dose. Recommended for adults with underlying medication conditions.
-for invasive pneumococcal prophylaxis in patients with high-risk conditions such as chronic heart disease, chronic lung disease (e.g., asthma treated with high-dose oral corticosteroids), and diabetes mellitus:
Intramuscular dosage (PCV13 or Prevnar 13):
Children 2 to 5 years of age: If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, a dose of PPSV23 is needed at least 8 weeks after the last PCV13 dose.
Intramuscular dosage (PCV15 or Vaxneuvance):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later. These doses do not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Intramuscular dosage (PCV20 or Prevnar 20):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 65 years and older who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated. This dose does not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23):
Adults 65 years and older who received previous vaccination with PPSV23 and PCV13: 0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV13 dose. Older adults who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.
Adults 65 years and older who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV15 dose.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13: 0.5 mL IM or subcutaneously as a single dose at least 1 year after the last dose of PCV13. This should be followed by 1 dose at age 65 years or older and at least 5 years apart from first dose.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV15 dose. These doses do not need to be repeated if given before age 65 years.
Adults 18 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
Children and Adolescents 2 to 17 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
-for invasive pneumococcal prophylaxis in patients with immunocompromising conditions (i.e., sickle cell disease and other hemoglobinopathies, anatomic or functional asplenia, congenital or acquired immunodeficiency, HIV infection, chronic renal failure, nephrotic syndrome, malignant neoplasms, leukemias, lymphomas, Hodgkin disease, solid organ transplantation, multiple myeloma, iatrogenic immunosuppression from drug or radiation therapy):
Intramuscular dosage (PCV13 or Prevnar 13):
Adults 18 years who are PCV13-naive and PPSV23-naive: 0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years).
Adults 18 years who received previous vaccination with PPSV23: 0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 and at least 8 weeks after a dose of PCV13 (Max: 2 doses of PPSV23 before age 65 years).
Children and Adolescents 6 to 17 years who are PCV13-naive and PPSV23-naive: 0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years).
Children and Adolescents 6 to 17 years who received previous vaccination with PPSV23: 0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 and at least 8 weeks after a dose of PCV13 (Max: 2 doses of PPSV23 before age 65 years).
Children 2 to 5 years: If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, 2 doses of PPSV23 are needed; first PPSV23 dose at least 8 weeks after the last PCV13 dose and second PPSV23 dose 5 years later.
Intramuscular dosage (PCV15 or Vaxneuvance):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later. These doses do not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Intramuscular dosage (PCV20 or Prevnar 20):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated.
Older Adults who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 65 years and older who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated. This dose does not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23):
Adults 65 years and older who received previous vaccination with PPSV23 and PCV13: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV13 dose. Older adults who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
Adults 65 years and older who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. These doses do not need to be repeated if given before age 65 years. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
Adults 18 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
Children and Adolescents 2 to 17 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.
-for invasive pneumococcal prophylaxis in patients with cerebrospinal fluid leak or cochlear implant:
Intramuscular dosage (PCV13 or Prevnar 13):
Adults 18 years who are PCV13-naive and PPSV23-naive: 0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23.
Adults 18 years old who are PCV13-naive, but received previous vaccination with PPSV23: 0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose.
Children and Adolescents 6 to 17 years who are PCV13-naive and PPSV23-naive: 0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23.
Children and Adolescents 6 to 17 years who are PCV13-naive, but received previous vaccination with PPSV23: 0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose.
Children 2 to 5 years: If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart and at least 8 weeks after the last PCV13 dose. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, a dose of PPSV23 is needed at least 8 weeks after the last PCV13 dose.
Intramuscular dosage (PCV15 or Vaxneuvance):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later. These doses do not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Intramuscular dosage (PCV20 or Prevnar 20):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 65 years and older who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated. This dose does not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23):
Adults 65 years and older who received previous vaccination with PPSV23 and PCV13: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV13 dose. Older adults who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.
Adults 65 years and older who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. This should be followed by 1 dose at age 65 years or older and at least 5 years apart from first dose.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. These doses do not need to be repeated if given before age 65 years.
Adults 18 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
Children and Adolescents 2 to 17 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
-for invasive pneumococcal prophylaxis in patients with chronic liver disease, alcoholism, or cigarette smoking:
Intramuscular dosage (PCV15 or Vaxneuvance):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later. These doses do not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Intramuscular dosage (PCV20 or Prevnar 20):
Adults 65 years and older who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated.
Adults 65 years and older who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 65 years and older who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history: 0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is not indicated. This dose does not need to be repeated if given before age 65 years.
Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20): 0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.
Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series: 0.5 mL IM as a single dose if PPSV23 is not available.
Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23):
Adults 65 years and older who received previous vaccination with PPSV23 and PCV13: 0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV13 dose. Patients who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.
Adults 65 years and older who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV15 dose.
Adults 19 to 64 years who are PPSV23-naive and received previous vaccination with PCV13: 0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV13 dose. This should be followed by 1 dose at age 65 years or older and at least 5 years from previous dose.
Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15: 0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV15 dose. These doses do not need to be repeated if given before age 65 years.
Adults 18 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
Children and Adolescents 6 to 17 years who are PPSV23-naive: 0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.
For otitis media prophylaxis in infants and children younger than 6 years:
Intramuscular dosage (PCV13 or Prevnar 13):
Children 24 to 71 months at first dose: 0.5 mL IM for 1 dose prior to the sixth birthday. The FDA-approved product labeling recommends a single dose for patients 15 to 71 months of age whereas the ACIP recommends a single dose for all children 14 to 59 months of age and for all children 60 to 71 months of age with underlying medical conditions.
Children 12 to 23 months at first dose: 0.5 mL IM for 2 doses administered at least 2 months apart.
Infants 7 to 11 months at first dose: 0.5 mL IM for 3 doses. Give the first 2 doses 4 to 8 weeks apart. The third dose should ideally be given at 12 to 15 months; it must be separated from the second dose by 2 months or more and given after the first birthday.
Infants 6 weeks to 6 months at first dose: 0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 to 15 months of age and at least 8 weeks after the third dose.
Intramuscular dosage (PCV20 or Prevnar 20):
Children 24 to 71 months at first dose: 0.5 mL IM as a single dose.
Children 12 to 23 months at first dose: 0.5 mL IM for 2 doses, separated by at least 2 months.
Infants 7 to 11 months at first dose: 0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 2 months.
Infants 6 weeks to 6 months at first dose: 0.5 mL IM for a total of 4 doses. Administer at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 2 months after the third dose.
Maximum Dosage Limits:
-Adults
0.5 mL/dose IM for PCV13 (Prevnar 13), PCV20 (Prevnar 20), and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).
-Geriatric
0.5 mL/dose IM for PCV13 (Prevnar 13), PCV20 (Prevnar 20), and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).
-Adolescents
0.5 mL/dose IM for PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).
-Children
2 to 12 years: 0.5 mL/dose IM for PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).
1 year: 0.5 mL/dose IM for PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20); safety and efficacy have not been established for PPSV23 (Pneumovax 23).
-Infants
6 weeks to 11 months: 0.5 mL/dose IM for PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20); safety and efficacy have not been established for PPSV23 (Pneumovax 23).
1 to 5 weeks: Safety and efficacy have not been established.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
*non-FDA-approved indication
Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Aspirin: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Caffeine; Dihydrocodeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Caffeine; Pyrilamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Chlorpheniramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Codeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Diphenhydramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Hydrocodone: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Pamabrom; Pyrilamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Acetaminophen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Albuterol; Budesonide: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Amlodipine; Celecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Dipyridamole: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Omeprazole: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Aspirin, ASA; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Benzhydrocodone; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Betamethasone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Bimekizumab: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to vaccines. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide; Formoterol: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Budesonide; Glycopyrrolate; Formoterol: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Bupivacaine; Meloxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Butalbital; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Butalbital; Acetaminophen; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Celecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Celecoxib; Tramadol: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Corticosteroids (systemic): (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Corticotropin, ACTH: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Cortisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Deflazacort: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Deucravacitinib: (Moderate) Patients receiving immunosuppressant medications may have a diminished vaccine response. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Dexamethasone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Diclofenac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Diclofenac; Misoprostol: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Diflunisal: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Diphenhydramine; Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Diphenhydramine; Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Elivaldogene Autotemcel: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to non-live vaccines. When feasible, administer indicated vaccines at least six weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Etodolac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Fenoprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Flurbiprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Hydrocodone; Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Hydrocortisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ibuprofen; Famotidine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ibuprofen; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ibuprofen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Indomethacin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ketoprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ketorolac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Meclofenamate Sodium: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Mefenamic Acid: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Meloxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Methylprednisolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Nabumetone: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Naproxen; Esomeprazole: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Naproxen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Nonsteroidal antiinflammatory drugs: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Ocrelizumab: (Moderate) Administer all non-live vaccines at least 2 weeks before ocrelizumab initiation, whenever possible. Ocrelizumab may interfere with the effectiveness of non-live virus vaccines. Attenuated antibody responses to tetanus toxoid-containing vaccine, pneumococcal polysaccharide and pneumococcal conjugate vaccines, and seasonal influenza vaccine were observed in patients exposed to ocrelizumab at the time of vaccination during an open-label study. Infants born to mothers exposed to ocrelizumab during pregnancy may receive non-live vaccines as indicated before B-cell recovery; however, consider assessing the immune response to the vaccine. ACIP recommends that patients receiving any vaccination during immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated a minimum of 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of, or in addition to, vaccination.
Ofatumumab: (Major) Administer all needed non-live vaccines according to immunization guidelines at least 2 weeks before initiation of ofatumumab. Ofatumumab may interfere with the effectiveness of inactivated vaccines due to its actions, which cause B-cell depletion.
Oxaprozin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Piroxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Prednisolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Prednisone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Satralizumab: (Major) Administer all non-live vaccines according to immunization guidelines at least 2 weeks before initiation of satralizumab.
Siponimod: (Moderate) Administer all non-live vaccines at least 2 weeks before siponimod initiation, whenever possible. Vaccines may be less effective if given during siponimod treatment. Patients should be considered unimmunized if vaccinated within a 14-day period before starting immunosuppresive therapy or during immunosuppressive therapy, and should they be revaccinated at least 3 months after therapy is discontinued if immune competence is restored.
Sulindac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Sumatriptan; Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Tolmetin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Tramadol; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
Triamcinolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Ublituximab: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to non-live vaccines. When feasible, administer indicated vaccines at least two weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Vamorolone: (Moderate) Patients receiving high-dose corticosteroid therapy may have a diminished response to vaccines. High-dose corticosteroid therapy is generally defined as a dose of at least 20 mg/day of prednisone or equivalent (or 2 mg/kg/day for patients weighing less than 10 kg) for at least 14 consecutive days. When feasible, administer indicated vaccines at least 4 weeks before planned high-dose corticosteroid therapy or wait at least 2 weeks after discontinuation. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving high-dose corticosteroids about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
The high virulence of the pneumococcal organism is largely due to its polysaccharide capsule, which inhibits phagocytosis by white blood cells. There are at least 90 known pneumococcal capsular types. The preponderance of pneumococcal disease, however, is caused by only a minority of these 90 types. Surveillance data revealed that 56% of all deaths due to pneumococcal pneumonia at a New York medical center from 1952 to 1962 were caused by only 6 different capsular types and that 78% of all pneumococcal pneumonias were caused by 12 capsular types. A similar pattern has been demonstrated throughout the world.
Non-conjugate pneumococcal vaccine, polyvalent: Non-conjugated polyvalent pneumococcal vaccines (Pneumovax 23) contain the capsular polysaccharides from the 23 most virulent and common strains of pneumococcus. The vaccines include the 6 most-commonly virulent serotypes: 6B, 9V, 14, 19A, 19F, and 23F. These 23 antigens represent roughly 90% of the reported types associated with clinical infection. Studies in humans have demonstrated the immunogenicity of each of the 23 antigens when tested in polyvalent vaccines; although, some of the serotypes are reported to be poor immunogens. Non-conjugated polysaccharide vaccines stimulate a T-cell independent immune response. Vaccine exposure stimulates the immune system to produce pneumococcal capsule-specific antibodies that make the organism more vulnerable to phagocytosis and other host-defenses. The antibody produced by these vaccines is primarily IgM, which affects vaccine efficacy. They do not induce T-cell dependent responses associated with immunologic memory. After revaccination, antibody titers increase, but an anamnestic response does not occur. Clinical trials suggest a protective efficacy of 60% to 90%.
Conjugated pneumococcal vaccine: Prevnar 13 is a 13-valent conjugate vaccine that contains 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F). Serotype 1 has been reported to be the most common cause of pneumococcal empyema (24% to 50% of cases), and serotype 19A is reported to be the most common cause of invasive pneumococcal disease since the introduction of Prevnar into the childhood immunization series. Vaxneuvance is a 15-valent conjugate vaccine that contains 15 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F). Prevnar 20 is a 20-valent conjugate vaccine that contains 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F).
The polysaccharides of the pneumococcal serotypes are bound to a non-toxic diphtheria protein known as CRM197. By coupling the polysaccharides to this carrier protein, a T-cell dependent immune response is generated. The conjugated polysaccharide (antigen) can then be presented by major histocompatibility complex molecules, which signals the activation of T-helper cells. The T-helper cells are then able to stimulate B-cells to mature into antibody-secreting plasma or memory cells. The exposure to the vaccine produces pneumococcal capsule-specific antibodies that make the organism more vulnerable to phagocytosis and other host-defenses.
Pneumococcal vaccine is administered intramuscularly. The PPSV23 (Pneumovax 23) formulation of the vaccine may be administered intramuscularly or subcutaneously. The distribution, metabolism, and excretion of the vaccines have not been well-defined. The immunologic response and duration of immunity conferred by pneumococcal vaccine is dependent upon the serotypes present in the vaccine and whether the polysaccharides are coupled/conjugated to various carrier proteins. In some individuals, immune response to the vaccine may not be sufficient to prevent pneumococcal infection.
-PCV13 (Prevnar 13): Patients who received Pneumovax 23 within 1 year prior to Prevnar 13 receipt experienced diminished immune responses to Prevnar 13 compared to Pneumovax 23 naive individuals.
-PCV15 (Vaxneuvance): Immune response to Vaxneuvance was similar to that seen after Prevnar 13 administration in clinical studies, including patients administered Pneumovax 23 six months to 1 year after Vaxneuvance or Prevnar 13.
-PCV20 (Prevnar 20): Patients who received Pneumovax 23 within 1 to 5 years prior to Prevnar 20 receipt experienced diminished immune responses to Prevnar 20 compared to patients who received Prevnar 13 at least 6 months prior and compared to patients who received Prevnar 13 followed by Pneumovax 23, with the last dose of Pneumovax 23 given at least 1 year prior to Prevnar 20.
-PPSV (Pneumovax 23): Immunity after injection occurs in 2 to 3 weeks. Antibodies against the vaccine serotypes develop in more than 80% of vaccinated healthy adults; older adults and patients with chronic illness or immunodeficiency may not respond well. Serotype-specific antibodies decline after 5 to 10 years; however, the rate of decline varies depending on the patient population. In healthy adults, increased antibody concentrations exist for at least 5 years. Data from 1 epidemiologic study suggest vaccination may provide protection for at least 9 years after the initial dose in adults; however, the correlation between serology and clinical protection is not firm. There is some evidence that revaccination can raise antibody concentrations and can ensure life-long immunity without significantly increasing the risk of adverse reactions. Revaccination is recommended for certain patients, such as those with immunosuppression.
-Special Populations
Pediatrics
Infants and Children 2 to 15 months
-PCV13 (Prevnar 13): In the pivotal U.S. non-inferiority trial comparing Prevnar 13 to Prevnar (PCV7), non-inferiority criterion was met for 10 of 13 serotypes after the third dose; the exceptions were serotypes 6B, 9V, and 3. For serotype 6B, 87.3% (95% CI, 82.5% to 91.1%) of patients who received Prevnar 13 achieved an antibody concentration 0.35 mcg/mL or greater 1 month after the third dose compared to 92.8% (95% CI, 88.9% to 95.7%) of those who received Prevnar. For serotype 9V, 90.5% (95% CI, 86.2% to 93.8%) of patients who received Prevnar 13 met the 0.35 mcg/mL threshold compared to 98.4% (95% CI, 96% to 99.6%) of those who received Prevnar. Although the criterion for non-inferiority was not met for serotypes 6B and 9V, the clinical significance of this is unknown. Of patients who received Prevnar 13, 63.5% (95% CI, 57.1% to 69.4%) achieved an antibody concentration of 0.35 mcg/mL or greater after the third dose. Serotype 3 is not included in the original Prevnar vaccine. After the fourth dose of Prevnar 13, non-inferiority criterion was met for 12 of 13 serotypes; the exception was serotype 3. Functional antibody responses, as measured by opsonophagocytic assay (OPA), were elicited for all 13 serotypes after 3 doses of Prevnar 13, and after the fourth dose, the OPA response was quantitatively greater than the responses after the third dose for each serotype.
-PCV15 (Vaxneuvance): In clinical trials, immune responses produced by Vaxneuvance after 4 doses were non-inferior to Prevnar 13 for the 13 shared serotypes based on serotype-specific IgG geometric mean concentrations.
-PCV20 (Prevnar 20): In clinical trials, immune responses 1 month after the fourth dose of Prevnar 20 were non-inferior to Prevnar 13 for all 13 shared serotypes based on serotype-specific IgG geometric mean concentrations. For the additional 7 serotypes, non-inferiority to serotype 1 (the lowest response of the 13 shared serotypes) was demonstrated.
-PPSV23 (Pneumovax 23): The antibody response to most serotypes is poor among pediatric patients younger than 2 years of age. Children, especially those with asplenia, nephrotic syndrome, or sickle cell disease, may have a decline in antibodies to pre-vaccination concentrations within 3 to 5 years.
Premature Neonates younger than 37 weeks
-PCV13 (Prevnar 13): In a study of 100 premature neonates (younger than 37 weeks gestation) who received 4 doses Prevnar 13 on a non-United States dosing schedule, serotype-specific IgG antibody responses were lower after the 3rd and 4th doses compared to responses among term infants (37 weeks gestation and older) for some serotypes. Immune responses elicited by the vaccine administered on the ACIP-recommended schedule to premature neonates are not known.
-PCV15 (Vaxneuvance): In studies of 142 premature neonates (younger than 37 weeks gestation) who received a 4-dose series, serotype-specific IgG and opsonophagocytic activity (OPA) responses at 30 days postdose 3, predose 4, and at 30 days postdose 4 were similar to those observed in term infants.
Geriatric
-PCV20 (Prevnar 20): Patients 70 years and older had a diminished immune response for all pneumococcal serotypes after Prevanr 20 administration compared to patients 64 years and younger.
Other
Adults with HIV Infection
-PCV13 (Prevnar 13): In an open-label study, 3 doses of Prevnar 13 were administered 6 months apart to adults with HIV infection (median age 48 years) and CD4 counts 200 cells/mm3 or more and serum HIV RNA titer less than 50,000 copies/mL. All had been previously vaccinated with Pneumovax 23 at least 6 months prior to enrollment. After the first Prevnar 13 dose, anti-pneumococcal opsonophagocytic activity (OPA) geometric mean antibody titers (GMTs) for all vaccine serotypes were higher than pre-vaccination concentrations (n = 227 to 253). OPA GMTs after the first, second, and third doses were generally comparable.
-PCV15 (Vaxneuvance): In a double-blind study in adults with HIV infection and CD4 counts 50 cells/mm3 or higher and serum HIV RNA titer less than 50,000 copies/mL, patients received a single dose of Vaxneuvance (n = 152) or Prevnar 13 (n = 150), followed by administration of Pneumovax 23 two months later. Serotype-specific OPA GMTs were higher after vaccination compared to pre-vaccination for all vaccine serotypes included in Vaxneuvance. After sequential administration with Pneumovax 23, OPA GMTs observed at 30 days after Pneumovax 23 vaccination were numerically similar between the 2 vaccination groups for all 15 serotypes contained in Vaxneuvance. The safety profile of Vaxneuvance was similar to the safety profile of Prevnar 13.
Pediatric patients with HIV Infection
-PCV13 (Prevnar 13): In an open-label study, 3 doses of Prevnar 13 were administered 1 month apart to patients 6 years and older with HIV infection and CD4 counts 200 cells/mm3 or higher and serum HIV RNA titer less than 50,000 copies/mL, who had not been previously vaccinated with Pneumovax 23. After the first dose, anti-pneumococcal OPA GMTs for all vaccine serotypes were higher than pre-vaccination concentrations (n = 197 to 257). OPA GMTs after the first, second, and third doses were generally comparable.
-PCV15 (Vaxneuvance): In a double-blind study in patients 6 to 17 years with HIV infection and CD4 counts 200 cells/mm3 or higher and serum HIV RNA titer less than 50,000 copies/mL, patients received a single dose of Vaxneuvance (n = 203) or Prevnar 13 (n = 204), followed by administration of Pneumovax 23 two months later. Serotype-specific IgG geometric mean concentrations (GMCs) and OPA GMTs were higher after vaccination compared to pre-vaccination for all vaccine serotypes included in Vaxneuvance. Serotype-specific IgG GMCs and OPA GMTs were numerically similar for the 13 shared serotypes and higher for the 2 unique serotypes (22F and 33F) at 30 days after vaccination with Vaxneuvance or Prevnar 13 and were numerically similar for all 15 serotypes contained in Vaxneuvance at 30 days after subsequent vaccination with Pneumovax 23. The safety profile of Vaxneuvance was similar to the safety profile of Prevnar 13.
Pediatric patients with Sickle Cell Disease
-PCV13 (Prevnar 13): In an open-label study, 2 doses of Prevnar 13 were administered 6 months apart to children and adolescents (6 to 17 years of age) with sickle cell disease. All patients had been previously vaccinated with Pneumovax 23 at least 6 months prior to enrollment. After the first Prevnar 13 dose, OPA GMTs for all vaccine serotypes were higher than pre-vaccination concentrations. OPA GMTs after the first and second dose were comparable.
-PCV15 (Vaxneuvance): In a double-blind study in patients 5 to 17 years with sickle cell disease comparing a single dose of Vaxneuvance (n = 70) to Prevnar 13 (n = 34), serotype-specific IgG GMCs and OPA GMTs were higher after vaccination compared to pre-vaccination for all vaccine serotypes included in Vaxneuvance. IgG GMCs and OPA GMTs were numerically similar between the 2 vaccination groups for the 13 shared serotypes and higher in Vaxneuvance for serotypes 22F and 33F. The safety profile of Vaxneuvance was similar to the safety profile of Prevnar 13.
Patients with Hematopoietic Stem Cell Transplant (HSCT)
-PCV13 (Prevnar 13): In an open-label study, 4 doses of Prevnar 13 were administered to patients (age 2 to 71 years) who had received an allogeneic hematopoietic stem cell transplant 3 to 6 months prior to enrollment. All had a history of stable engraftment and did not have uncontrolled graft versus host disease. The first 3 doses were administered a month apart and the fourth dose was administered 6 months after the third dose. Sera were obtained approximately 1 month after each vaccination. Immune responses (IgG GMCs) were numerically higher after the first dose of Prevnar 13 compared with baseline. Similarly, IgG GMCs were numerically higher after each subsequent dose compared to the previous dose. A post hoc analysis of immune response, measured by OPA antibody assay, showed the pattern of functional antibody response to be consistent with IgG response for each serotype.