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Recommendations for pneumococcal vaccination of at-risk children: a global overview (2022-2024)
Derek Daigle1, Graciela Morales2, Kyla Hayford3
1Pfizer Vaccines and Antivirals, US Medical Affairs, New York, NY, USA.
Insights
Pneumococcal vaccination policies for at-risk children are uncommon, with only about one-third of countries offering them. When available, these specialized schedules for pneumococcal conjugate vaccine (PCV) and polysaccharide vaccine (PPV23) vary significantly.
Area of Science:
- Public Health
- Vaccinology
- Pediatrics
Background:
- Pneumococcal diseases pose a significant global threat to child health, causing substantial morbidity and mortality.
- Children with specific underlying health conditions face a heightened risk of pneumococcal infection and severe disease.
- This report examines pneumococcal vaccination policies designed for high-risk pediatric populations.
Purpose of the Study:
- To provide an overview of global pneumococcal vaccination policies.
- To focus specifically on vaccination strategies for children at increased risk of pneumococcal disease.
Main Methods:
- Systematic retrieval of risk-group targeted vaccination schedules from international health organizations (WHO, ECDC) and national governmental/public health websites.
- Gathering supplementary information from governmental sources and field experts.
Main Results:
- Approximately 37.9% of 195 countries provide specific vaccination policies for at-risk children.
- Among these, 85.1% recommend differentiated schedules, often involving pneumococcal conjugate vaccine (PCV) boosters followed by 23-valent polysaccharide vaccine (PPV23).
- Recommendations vary widely regarding vaccine types (PCV13, PCV15, PCV20, PPV23), schedules, and targeted risk conditions.
Conclusions:
- Tailored pneumococcal vaccination schedules for high-risk children are not widely implemented, unlike routine infant schedules.
- Existing risk-group recommendations exhibit considerable heterogeneity in vaccine choice, dosing, and covered conditions.
- Enhanced guideline development and improved vaccine accessibility are crucial for protecting at-risk children against pneumococcal disease.
Background:
Pneumococcal diseases have a major impact on childhood morbidity and mortality across the world. While any child could be infected, those with certain health conditions have an increased risk of infection and subsequent disease severity. This report provides an overview of pneumococcal vaccination policies focused on children considered to be at particular risk of pneumococcal disease.
Methods:
Risk-group targeted vaccination schedules were retrieved from the World Health Organization and the European Centre for Disease Prevention and Control portals, and from countries' official governmental and/or public health websites. Additional information was gathered directly from governmental sources and specialists working in the field.
Results:
Of the 195 countries considered, 37.9% (74/195) provide information on vaccination policies for children with risk factors, with 85.1% of these (63/74) recommending a differentiated pneumococcal vaccination schedule. Among countries with recommendations, 65.1% (41/63) suggest administration of one or more pneumococcal conjugate vaccine (PCV) boosters after the general infant vaccination schedule, followed by the administration of the 23-valent polysaccharide vaccine (PPV23). In contrast, 12.7% of countries (8/63) recommend only subsequent PPV23, whereas 20.6% (13/63) recommend the administration of only PCV revaccination. PCV13 is the most frequently recommended PCV, while the higher-valency PCV15 and PCV20 are already recommended by five countries. Overall, risk-targeted recommendations vary widely according to the vaccination schedule employed, the risk conditions considered, and the level of detail of the recommendations.
Conclusions:
Pneumococcal vaccination schedules specifically tailored for children with risk factors are relatively exceptional - present in about one-third of countries - in contrast to the more widely adopted routine infant vaccination schedules. When available, these risk-group recommendations vary widely by conditions and dosing. Continued guidelines development and vaccine access are needed to support the provision of pneumococcal vaccination to children with risk factors.
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