Any Merit to Prevnar in Light of H1N1?

[not_telling]

So, I've posted this question is a few existing threads, but either my question's gotten lost amongst the other things being discussed in said thread, or no one knows the answer or....

Anyway, DS is 15 months. I was planning on not doing Prevnar. "They" are recommending Prevnar for those under 2 and the Pc-23 for those above 2 years to lessen the likelihood of secondary bacterial pneumonia infection. They say s. pneumococcus is the bacteria they're finding most often - BUT, they never say which strains! I can kinda understand, then, why folks may want to get the one that covers 23 strains, but I'm feeling unsure about the efficacy of Prevnar because my understanding is that the 7 strains covered are no longer the most prevalent.

If my DS has not had Prevnar, is he more likely to have these 7 strains already in his throat (since about 1/3 of kids walk around every day with Pc strains apparently)?

My ped is a Prevnar-pusher and I know she will use H1N1 as a further argument for why DS should get it. I understand the basics of the whole serotype replacement issue and I did see someone on here suggest that if someone's going to get a secondary infection, then they would get it from whatever bacteria is available to take advantage of the situation. Is this really how it works?

I wavered on Prevnar for so long and felt really good when I made a "final" decision about a month ago...and now that everyone's talking about complications from pneumonia I'm back to wavering again.

I have searched and searched on the internet for exactly what strains of Pc they're finding....anyone know how to find this info?

[carfreemama]

I have an extremely robust 5 year old. We selectively (and now not at all) vaxed starting at 2.5 years old. Never had a flu shot, chicken pox vax, etc. Never had Prevnar. But I've been reading the same things. I called her ped and asked what he thought and he did suggest it "might not be a bad idea;" though she is not in any risk group. I asked if he would give the adult pneumococcal vaccine (I guess Pneumovax here), but he said no, it would be Prevnar. He said she would only need one dose. I am seriously considering this, but not sure why he would still give her the Prevnar and not the other. So does Pneumovax cover more strains? We're in Canada, BTW.

It seems ridiculous to be considering this, given that dd has never had so much as an ear infection, let alone pneumonia. However, I'm generally somewhat panicky about dd and illness (though I know this is largely my own emotional issue) and here I am considering it. I'm not sure I can go through with it, though.

[girlsmamma2]

I am totally with ya on this. I have no idea where this information is, or why they aren't pushing the 23 strain vax more. I too feel funny considering a vax usually reserved for people with "no spleen" etc like my fp put it. But I do think this is a special case since this seems to be more of an issue with this particular illness. I just don't know what to do.

I do think it's curious why your ped would give Prevnar over the other one though. Maybe he is reserving the 23 strain one for high risk groups? Maybe trying to push Prevnar more? I do know that I would want the one that covers more strains and has been around much longer than go the risks of another shot and it only covers 7 strains that aren't as prevalent anymore. That part seems strange.

Is it just me or is every single piece of information put out there immediately discounted by the next piece of information about this whole h1n1. I guess it is just unknown but I do wonder why there is not a lot of pushing surrounding this Pneumonia vax. Maybe because they don't want the demand for that to take away from the swine flu vax.

[not_telling]

well, in DS's case he is not eligible for the one that covers 23 strains because it's not for kids under 2 yrs. old.

I did read that there's a glitch in Utah where somehow they know that the most prevalent strains of pneumococcus in their state are different than the ones covered by the Pc vaxes. How they know this, I do not know, but it's in their newspapers. I tried finding info about my state and prevalent strains, but got nowhere. I know there's people here (on MDC) who are really adept at finding this info, so I hope someone will come to our rescue.

[GearGirl]

I'm not of any help here, but I wanted to thank you for the heads up on this issue!

[peilover010202]

I'm feeling the same way. I've not had any luck in making a decision or finding the info you are looking for. My doc just tells me to vax for everything, so he's no help either.

[mbro]

I am interested in this topic as well. In fact, I was just about to post the same question...though my DD will be 3 in February. Anyone????

Thanks!

[KJoy]

From an article in the Canadian Journal of Infectious Diseases

PCV7 (Prevnar) contains serotypes 4, 6B, 9V, 14, 18C, 19F and 23F

This report, recently published in MMWR, identifies the S.Pneumoniae serotypes responsible for bacterial coinfections in a sampling of H1N1 deaths; they include 15B/C,10F,10C,33C,15A,15F,6A/B,11A,11B. Only the 15B/C serotype was a pediatric case. All others are >27yo. I'm still searching for more comprehensive data too.

This report outlines who should receive the 23-valent pneumo vaccine.

(ACIP) recommends a single dose of PPSV23 for all people 65 years and older and for persons 2 to 64 years of age with certain high-risk conditions

and

Use of PPSV23 among people without current indications for vaccination is not recommended at this time. This recommendation may be revised as the epidemiology and clinical presentation of novel influenza A (H1N1) virus infection as well as the frequency and severity of secondary pneumococcal infections are better understood.

Other med journal articles I looked at state that children <2yo have a poor immunologic response to PPSV23 - guess that's why they're not pushing it right away.

[not_telling]

Awesome researching, KJoy! Thank you!!

I remember reading, re. the efficacy of Prevnar, that not only did it drastically reduce infections due to the strains covered, but there was some cross-strain coverage (not sure of the correct medical jargon here) too. I was thinking that meant there was reduction in infections caused by some strains not covered by Prevnar. I don't know which additional strains this was true for, but it certainly feels important that the strains implicated in that recent MMWR report are not covered by Prevnar.

[not_telling]

Just read through that MMWR report and two things stood out for me.

One, "They" are still saying it's important for young kids to receive Prevnar - I'm trying to understand why (!!).

Two, the data was collected from 8 states, one of which was Utah. Utah, though, apparently has different "most prevalent" s. pneumococcus strains than the rest of the country. So, I wonder if that skews things a bit for those of us who don't live in Utah.

[KJoy]

Originally Posted by not_telling

Utah, though, apparently has different "most prevalent" s. pneumococcus strains than the rest of the country. So, I wonder if that skews things a bit for those of us who don't live in Utah.

That's interesting. The thing that struck me in reading through some reports is just how little they know b/c typing isn't being done for the secondary infections. One of the reports actually was a call for more data and more typing to be done in autopsies. I'll try to find that again. Maybe they're counting on that cross-strain coverage you mentioned (although, I've heard more about serotype replacement where Prevnar is just allowing other strains to become more virulent and prevalent???)

[Deborah]

insidevaccines has done several articles on Prevnar with extensive discussion of the serotype replacement problem.
http://insidevaccines.com/wordpress/...s=prevnar+6%25

[lurve]

i am not going to be of any help i just wanted to add my anctedal story: my nehew got swine flu (supposedly, positive for Type A but of course we are learning that doesn't mean anything...). he is fully faxed so he had prevnar. he got pneumococcus...

[iris777888]

I've never seen an explanation as to why they don't recommend PPSV23 for all kids over two though, and not just the at risk groups. The CDC guidance doc says:

"Use of PPSV23 among people without current indications for vaccination is not recommended at this time. This recommendation may be revised as the epidemiology and clinical presentation of novel influenza A (H1N1) virus infection as well as the frequency and severity of secondary pneumococcal infections are better understood."

I found it interesting that they are still pushing Prevnar though, while at the same time admitting it's pretty much useless in this instance:

"While maintaining this high coverage is important, expanding the use of PCV7 to people aged ≥ 5 years is not indicated because circulation of the 7 serotypes included in the vaccine has declined substantially and disease caused by these serotypes is now uncommon."

[NoCalMomOfTwo]

Originally Posted by iris777888

I've never seen an explanation as to why they don't recommend PPSV23 for all kids over two though, and not just the at risk groups. The CDC guidance doc says:

"Use of PPSV23 among people without current indications for vaccination is not recommended at this time. This recommendation may be revised as the epidemiology and clinical presentation of novel influenza A (H1N1) virus infection as well as the frequency and severity of secondary pneumococcal infections are better understood."

I found it interesting that they are still pushing Prevnar though, while at the same time admitting it's pretty much useless in this instance:

"While maintaining this high coverage is important, expanding the use of PCV7 to people aged ≥ 5 years is not indicated because circulation of the 7 serotypes included in the vaccine has declined substantially and disease caused by these serotypes is now uncommon."

I don't understand why they aren't pushing Pneumovax either! It seems like if you were going to push something, why not the thing that can prevent 90% of pneumococcal infections? I think I read that somewhere in those links anyway. If you're going to get something, seems much more preventative to get this than h1n1 vaccine to me, but maybe I am missing something? Just seems like it would protect you from secondary infection from this flu and then also from any others that come down the road. And aren't the secondary infections what are leading to most of the problems/hospitalizations?

[jeanine123]

Will it protect you from secondary infections? Are those infections caused by the same strains that Pneumovax protects against or are they being caused by one of the strains that isn't in the vax that may have been gaining strength over the years that this vax has been available? From what I remember reading about this topic, while the cases of pneumonia caused by the strains found in this vax has gone down, quite a bit in fact, the overall cases of pneumonia haven't decreased due to serotype replacement. That's my concern, the bug that is causing the secondary infections may not be the one found in the vaccine. In which case you've exposed your body to all of the stuff in the vax for nothing, not to mention the potential side effects as well as taxing your immune system unnecessarily during a time of year when it usually faces most of it's challenges.

[Marnica]

Originally Posted by jeanine123

Will it protect you from secondary infections? Are those infections caused by the same strains that Pneumovax protects against or are they being caused by one of the strains that isn't in the vax that may have been gaining strength over the years that this vax has been available? From what I remember reading about this topic, while the cases of pneumonia caused by the strains found in this vax has gone down, quite a bit in fact, the overall cases of pneumonia haven't decreased due to serotype replacement. That's my concern, the bug that is causing the secondary infections may not be the one found in the vaccine. In which case you've exposed your body to all of the stuff in the vax for nothing, not to mention the potential side effects as well as taxing your immune system unnecessarily during a time of year when it usually faces most of it's challenges.

[iris777888]

The information for PPSV23 says it is for serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F.

Of the ones listed as H1N1 secondary infections in KJoy's post above, the pneumovax would have covered you for 6B, 11A and 15B, so 27%. So a guess is that it would protect against some secondary infections, at least for awhile!

Ultimately serotype replacement would still be likely to occur. Based off some info I read recently, in 2004 there were 1,343 known serotypes (and growing)! Even the CDC admits that serotype replacement is an issue with pneu. infections, even more so as the number vaccinated grows.

[rileyscoutmom]

Here's my 2 cents on the issue:

My dd got the prevnar vaccine at 4 months. It is the only vaccine she has received except for the HEB B at birth (one dose). After receiving the vaccine she completely stopped using the left side of her body and she ceased all babbling. She also had a double ear infection for 2 months. It is the ONLY time she has been ill (except for some food intolerance/allergy issues). There are other reports of vaccine injury in the VAERS database. After a lot of work she is now totally on track phsyically in her development, we are still unsure about the other part of it.

[KJoy]

Originally Posted by NoCalMomOfTwo

I don't understand why they aren't pushing Pneumovax either!

I wondered this too. It looks like this is why:

From (this article)

However, the capsular polysaccharide pneumococcal vaccines used to immunize adults are neither immunogenic nor protective in young children due to poor antibody responses

And here, in a review of a UK policy to vaccinate with two doses of PCV7 followed by a dose of PPSV23:

Vaccinated children had 7-30-fold higher antibody concentrations than unvaccinated children to all serotypes contained in the PCV-7 (P<0.001). In contrast, serotypes covered by the PPV-23 but not PCV-7 were only one- to two-fold higher and there was no significant increase in the number of children who had protective concentrations of antibody (> or =0.35 mcg/ml) against these serotypes

In this cohort of children, PPV-23 vaccine did not broaden the protection in vitro against potentially pathogenic strains of Streptococcus pneumoniae. We call into question the recommendation to use the PPV-23 in children.