Prevenar 13 is administered on the National Immunisation Schedule as a primary course at 6 weeks and 5 months of age, followed by a booster dose at 12 months of age.

Prevenar 13 is funded for children and adults with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule, identified as 'special groups on the National Immunisation Schedule. In children with an eligible medical condition, Prevenar 13 is given at 6 weeks, 3 months and 5 months and 12 months of age.

Prevenar 13 is available as a purchased vaccine for people with a medical condition that is not listed on the Pharmaceutical Schedule.

Special groups

Prevenar 13 is recommended and funded as below.

Two doses of PCV13 are funded for high risk tamariki (over the age of 12 months and under 18 years, who have previously received two doses of the primary course of PCV10, or up to an additional four doses (as appropriate) for (re-)immunisation of individuals:

Children aged under 5 years

• Cardiac disease with cyanosis or failure
• Cerebrospinal fluid leak
• Chronic pulmonary disease, including asthma treated with high-dose corticosteroid therapy
• Cochlear implant
• Corticosteroid therapy for more than two weeks and who are on an equivalent daily dosage of prednisone of 2 mg/kg per day or greater, or children who weigh more than 10 kg on a total daily dosage of 20 mg or greater
• Diabetes
• Down syndrome
• Functional asplenia
• HIV-positive
• Immunosuppressive therapy
• Intracranial shunt
• Nephrotic syndrome
• Pre-or post-splenectomy
• Pre-term infant born before 28 weeks gestation
• Primary immune deficiency
• Post-haematopoietic stem cell transplantation
• Post-solid organ transplantation
• Radiation therapy
• Renal failure

Children aged 5 years or older, and adults

• Cochlear implant
• Complement deficiency (acquired or inherited)
• Functional asplenia
• HIV-positive
• Post-haematopoietic stem cell transplantation
• Pre- or post-chemotherapy
• Pre- or post-splenectomy
• Pre- or post-solid organ transplantation
• Primary immunodeficiency
• Renal dialysis

Note: Pneumovax23 (pneumococcal polysaccharide vaccine) is also funded for these groups from 2 years of age, and should also be administered at least 8 weeks after Prevenar13. (Pneumovax23 is only funded post chemotherapy).

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Catch-up doses

High risk children under 5 years who have not completed a course of PCV13 vaccine are eligible to receive age-appropriate catch up doses.

For those people meeting special groups eligibility, Prevenar 13 should be administered at least 8 weeks before Pneumovax 23. However, missed doses of Prevenar 13 can be given even if the person has previously received one or more doses of Pneumovax23. There are no safety concerns expected, but it is possible for prior doses of Pneumovax23 to reduce an individual’s immune response to Prevenar 13.

For adults aged 18 years or older who received Pneumovax23 before a dose of Prevenar 13 - Prevenar 13 should be given at least one year after Pneumovax23.

For children aged 2 years to under 18 years who received Pneumovax23 before a dose of Prevenar 13 - Prevenar 13 should be given at least eight weeks after Pneumovax23.

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Storage and preparation

Upon storage, the vaccine may separate into a white deposit and clear liquid. The vaccine should be well shaken to obtain a consistent white suspension. Do not use if the content appears otherwise.

Store as per cold chain between 2°C to 8°C.

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Administration

Prevenar 13 can be administered concurrently with other vaccines, including all the National Immunisation Schedule vaccines except other pneumococcal vaccines, e.g. Pneumovax23. Separate syringes and different injection sites should be used.

Systemic reactions (chills, rash and myalgia) may occur when Prevenar 13 and influenza vaccine are administered at the same time. If a child aged under 5 years needs both Prevenar 13 and influenza vaccines, separation of vaccines by two days can be offered. If the child has a history of febrile convulsions, separation of the vaccines is recommended.

The vaccine is administered intramuscularly, into the vastus lateralis or the deltoid muscle in older children and adults.

The benefit of vaccination in very premature infants and those with a previous history of respiratory immaturity is high. Vaccination should not be withheld or delayed in these babies, however, respiratory monitoring should be considered for 48–72 hours due to the potential risk of apnoea.

Prevenar 13 should not be given to:

• Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or other pneumococcal-containing vaccine, or a component of the vaccine
• Administration of Prevenar 13 should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

Specialist advice should be sought for the following groups:

• Those with bleeding disorders, such as haemophilia The vaccine should be administered in accordance with the haematologist’s instructions. It may, in this situation only, be given subcutaneously

There is good evidence that pneumococcal conjugate vaccines given in infancy help to protect non-vaccinated individuals from invasive pneumococcal disease caused by serotypes in the vaccines through community (herd) immunity.

A study in Germany showed a marked decrease in the incidence of non-meningitis invasive pneumococcal disease (IPD) caused by PCV13 serotypes following the introduction of Synflorix and Prevenar 13. This decrease was not only observed in infants younger than 2 years but also older children, indicating herd immunity. In this study, an overall decrease in meningitis was limited to vaccinated children aged 2–4 years.

Herd effects from Prevenar 13 result from the impact of this vaccine on pneumococcal nasopharyngeal carriage in vaccinated infants. In a French study, overall carriage was reported to be significantly lower among children who received at least one doses of Prevenar 13 compared with those who were exclusively vaccinated with Prevenar.

Data has shown a decline in otitis media (middle ear infection) following the routine introduction of pneumococcal conjugate vaccines to the schedule. However, otitis media also caused by other types of bacteria which are not protected against by this vaccine.

• Medsafe. New Zealand data sheet: Prevenar 13 [Internet]. Wellington: New Zealand Medicines and Medical Devices Safety Authority; 2010 [updated 2019 August 22; cited 2020 July 1]. Available from: http://www.medsafe.govt.nz/profs/Datasheet/p/prevenar13inj.pdf
• Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
• Plosker GL.13-valent pneumococcal conjugate vaccine: a review of its use in infants, children, and adolescents. Paediatric Drugs. 2013;15(5):403-23
• Plosker GL.13-valent pneumococcal conjugate vaccine: a review of its use in adults. Drugs. 2015;75(13):1535-46
• Weiss S, Falkenhorst G, van der Linden M, Imöhl M, von Kries R. Impact of 10- and 13-valent pneumococcal conjugate vaccines on incidence of invasive pneumococcal disease in children aged under 16 years in Germany, 2009 to 2012. Euro Surveill. 2015;20(10):pii=21057