Current Advisory Committee on Immunization Practices (ACIP) guidelines recommend pneumococcal 7-valent conjugate vaccine (PCV7) be used for children 2-23 months of age and, in certain situations, children up to 59 months of age

Patients who will be receiving immunosuppressive therapy (including Hodgkin's disease, cancer chemotherapy, or transplantation) should be vaccinated at least 2 weeks prior to the initiation of therapy. Immune responses may be impaired for several months following intensive immunosuppressive therapy (up to 2 years in Hodgkin's disease patients). Patients who will undergo splenectomy should also be vaccinated 2 weeks prior to surgery, if possible. Patients with HIV should be vaccinated as soon as possible (following confirmation of the diagnosis). Not recommended in children 2 years of age.

>10%: Local: Induration and soreness at the injection site (~72%) (2-3 days)

<1%: Anaphylaxis, arthralgia, erythema, Guillain-Barré syndrome, low-grade fever, myalgia, paresthesia, rash

Children >2 years and Adults: 0.5 mL

Previously vaccinated with PCV7 vaccine: Children 2 years and Adults:

With sickle cell disease, asplenia, immunocompromised or HIV infection: 0.5 mL at 2 years of age and 2 months after last dose of PCV7; revaccination with PPV23 should be given 5 years for children >10 years of age and every 3-5 years for children 10 years of age; revaccination should not be administered <3 years after the previous PPV23 dose

With chronic illness: 0.5 mL at 2 years of age and 2 months after last dose of PCV7; revaccination with PPV23 is not recommended

Following bone marrow transplant (use of PCV7 under study): Administer one dose PPV23 at 12- and 24-months following BMT

Revaccination should be considered:

1. If 6 years since initial vaccination has elapsed, or

2. In patients who received 14-valent pneumococcal vaccine and are at highest risk (asplenic) for fatal infection or

3. At 6 years in patients with nephrotic syndrome, renal failure, or transplant recipients, or

4. 3-5 years in children with nephrotic syndrome, asplenia, or sickle cell disease

For patients at risk of hemorrhage following intramuscular injection, the ACIP recommends "it should be administered intramuscularly if, in the opinion of the physician familiar with the patients bleeding risk, the vaccine can be administered with reasonable safety by this route. If the patient receives antihemophilia or other similar therapy, intramuscular vaccination can be scheduled shortly after such therapy is administered. A fine needle (23 gauge or smaller) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection."

Advisory Committee on Immunization Practices (ACIP), "Pneumococcal Vaccination for Cochlear Implant Recipients,"MMWR Morb Mortal Wkly Rep, 2002, 51(41):931.

Advisory Committee on Immunization Practices (ACIP), "Prevention of Pneumococcal Disease,"MMWR Recomm Rep, 1997, 46(RR-8):1-31.

Centers for Disease Control, "Recommendations of the Advisory Committee on Immunization Practices (ACIP): General Recommendations on Immunization,"MMWR Recomm Rep, 1994, 43(RR-1):23.

Davidson M, Bulkow LR, Grabman J, et al, "Immunogenicity of Pneumococcal Revaccination in Patients With Chronic Disease,"Arch Intern Med, 1994, 154(19):2209-14.

Gardner P and Schaffner W, "Immunization of Adults,"N Engl J Med, 1993, 328(17):1252-8.

"Preventing Pneumococcal Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention,"MMWR Recomm Rep, 2000, 49(RR-9):1-35.

U.S. Department of Health and Human Services, "Prevention of Pneumococcal Disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP),"MMWR Recomm Rep, 1997, 46(RR-8):1-24.