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4 Pediatric Pneumococcal Vaccine Conundrums


Throughout my 40+ years as a physician, the pediatric vaccine schedule has become increasingly complicated. When I started in 1979, a child would receive 4 shots total and 3 oral vaccines protecting againt 7 diseases in the first year of life. Today, in my office, the same-aged child will have received 13 shots and 3 oral vaccines protecting against 12 diseases in that first year.

Currently, 2 pneumococcal vaccines have been approved by the US Food and Drug Administration for use in children: Prevnar 13™ (PCV13) and Pneumovax® (PPSV23). PCV13 is recommended for all children aged <2 years; for children aged 2-18 years with specific underlying conditions, the CDC recommends both PPSV23 and PCV13.

Since I think it can still be confusing, let's look at some conundrums that can occur.

1. A 26-month-old unvaccinated boy is brought to your office by grandparents with legal custody following a car accident that killed both parents and they want to get their new ward fully vaccinated. The child has asthma and is on daily inhaled steroids. With regard to the pneumococcal vaccines, you tell the grandparents the child needs:

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