NACI Recommendation for Prevnar®

744

In January 2002, the National Advisory Committee on Immunization (NACI) recommended Prevnar(r) (Pneumococcal 7-Valent Conjugate Vaccine) be included as part of the routine immunization schedule for Canadian children. Prevnar has been available in Canada since last year. It’s the first and only vaccine to effectively prevent pneumococcal disease in infants and young children.

The NACI recommendation acknowledges the importance of protecting against pneumococcal disease. Those particularly at risk include all infants from birth to 24 months; children with weakened immune systems, including sickle cell disease and HIV; children who attend daycare; and children who have taken antibiotics within the preceding three-month period. Prevnar is also recommended for use in aboriginal infants and children, and those of African descent. These groups have a higher risk of developing invasive pneumococcal infections than the general population.

The objective of NACI is to advise Health Canada on the use of vaccines currently or newly licensed for use in humans in Canada, including the identification of high-risk groups that vaccine programs should be targeting. NACI also advises on the need for national vaccination strategies. However, immunization programs are funded by each province’s ministry of health and can therefore vary across the country.

Pneumococcal Vaccination ProgramsIn Alberta, all children born after July 1st are eligible for vaccination. This program began on September 1st. In Saskatchewan, children under two at high risk of developing pneumococcal disease will be inoculated.

Other programs are also in place. In Nunavut, all children under two and those at high risk under five years of age will receive the vaccine. In Northern Quebec (Nunavik), children at high risk under five years of age are vaccinated.

Prevnar is also available to anyone with a prescription – some private insurers cover the cost of the immunization.

IncidenceEvery year in Canada, over half a million cases of pneumococcal disease strike infants and children. Thousands of Canadian children also undergo surgical ear tube insertion to manage recurrent ear infection. Many of these cases can be prevented through vaccination.

Pneumococcal disease is expensive to treat, totalling nearly $58 million annually. Costs include unscheduled physician visits, surgical interventions and hospitalization. Pneumococcal disease also results in lost work time for parents who stay home to care for children missing school or daycare.

The DiseasePneumococcal disease results from the bacteria Streptococcus ( S.) pneumoniae. This bacteria is the leading cause of serious childhood infections including meningitis, bacteremia (bloodstream infections), pneumonia and otitis media (ear infection).

Prevnar protects against seven strains of S. pneumoniae bacteria, specifically serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. These seven strains account for approximately 80 per cent of all invasive pneumococcal disease in Canadian children under the age of five. They are also among the most resistant to antibiotics.

In the past, pneumococcal disease could be treated effectively with antibiotics, particularly penicillin. In the last 20 years, however, there has been an alarming increase in S. pneumoniae strains that are resistant to penicillin and other antibiotics. A Canadian study recently showed that penicillin-resistant pneumococci has increased from two per cent in 1988 to nearly 15 per cent in 2001. Children infected with drug-resistant strains may be sick longer, requiring further – and more expensive – courses of antibiotics as well as hospitalization.

TransmissionPneumococcus is most often found in the nose and throat of healthy children and adults. Up to four different serotypes of the bacteria can be carried at the same time. While not everyone will become sick from pneumococcus, anyone whom the bacteria have colonized is a carrier. Carriers can potentially infect others through airborne particles, as in sneezing or coughing.

The colonization of pneumococci in young children is very common, since they lack the needed antibodies to fight the bacteria prior to colonization. Children are therefore major carriers and victims of pneumococcal disease.

SafetyIn clinical studies conducted in the United States, France, Germany, the United Kingdom and Finland, Prevnar was used among tens of thousands of children and was well tolerated. Typical reactions were mild and comparable to those seen with other vaccines. The most frequently reported side effects included injection site reactions, fever, irritability, drowsiness, restless sleep, decreased appetite, vomiting, diarrhea and rash or hives.