Canada Communicable Disease Report
Volume 29 ACS-8
15 September 2003

An Advisory Committee Statement (ACS) 
National Advisory Committee on Immunization (NACI)*^†

STATEMENT ON THE RECOMMENDED USE OF PNEUMOCOCCAL CONJUGATE VACCINE: ADDENDUM

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Preamble

The National Advisory Committee on Immunization (NACI) provides Health Canada with ongoing and timely medical, scientific, and public health advice relating to immunization. Health Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge, and is disseminating this document for information purposes. People administering or using the immunizing agent should also be aware of the contents of the relevant product monograph(s). Recommendations for use and other information set out here may differ from that set out in the product monograph(s) of the Canadian licensed manufacturer(s) of the immunizing agent(s). Manufacturer(s) have sought approval of the immunizing agent(s) and provided evidence as to its safety and efficacy only when it is used in accordance with the product monographs.

On 15 January, 2002, the National Advisory Committee on Immunization published a Statement on Recommended Use of Pneumococcal Conjugate Vaccine⁽¹⁾. Use of this vaccine was also included in the recently published 6^th edition of the Canadian Immunization Guide⁽²⁾. Several questions have arisen related to the best practice to follow for children whose immunization schedule with this vaccine is interrupted, an issue that was not specifically addressed in either the previous statement or the recent Canadian Immunization Guide. This addendum details the recommendations for resumption of immunization with the pneumococcal conjugate vaccine in the case of an infant or child's pneumococcal immunization schedule being interrupted.

Although these children have likely received some benefit from their previous immunization(s) with the pneumococcal conjugate vaccine, this cannot be guaranteed. Therefore, in general, children > 12 months of age who present for pneumococcal immunization after an interruption of their conjugate pneumococcal immunization schedule should be further immunized according to the recommended schedule for their age at the time of re-presentation as if they had not been previously immunized (Table 1). Children who are < 6 months of age when they re-present should complete their immunization schedule as if no interruption had occurred. The recommendations for children between 7 and 11 months are based upon whether they had previously received one or two vaccine doses.

Children at high risk of invasive pneumococcal disease, as detailed in the previous statement and the 6^th Canadian Immunization Guide, who are < 2 years of age should follow the immunization schedule described for healthy children. Children at high risk of invasive pneumococcal disease who are >= 2 years of age when they re-present and who have previously received one or more doses of the conjugate pneumococcal vaccine should receive one additional dose of the conjugate pneumococcal vaccine. The use of polysaccharide vaccine in children at high risk of invasive pneumococcal disease should be instituted according to the recommendations in both the previous statement and the Canadian Immunization Guide.

Table 1.     Suggested immunization schedule for children whose conjugate pneumoccocal vaccination schedule has been interrupted 

*    For children vaccinated at < 1 year of age, the minimum interval between vaccine doses is 4 weeks.
**    Booster doses to be given at least 6 to 8 weeks after the final dose of the primary series.

References 

1. National Advisory Committee on Immunization. Statement on recommended use of pneumococcal conjugate vaccine. CCDR 2002;28(ACS-2):1-32, 2002. 

2. National Advisory Committee on Immunization. Canadian immunization guide, 6^th ed. Ottawa: Health Canada, 2002: 177-184. Cat. No. H49-8/2000E.

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