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  • CLASSES

    Pneumococcal Vaccines

    DEA CLASS

    Rx

    DESCRIPTION

    Multivalent vaccines against Streptococcus pneumoniae
    Used for immunization against invasive pneumococcal disease and other infections caused by S. pneumoniae
    Routine vaccination recommended for all geriatric patients and pediatric patients up to 5 years of age; vaccination also recommended for adults and patients 2 years and older with underlying medical conditions

    COMMON BRAND NAMES

    Pneumovax 23, Prevnar 13, Prevnar 20, VAXNEUVANCE

    HOW SUPPLIED

    Pneumovax 23 Intramuscular Inj Sol
    Pneumovax 23 Subcutaneous Inj Sol
    Prevnar 13/Prevnar 20/VAXNEUVANCE Intramuscular Inj Susp

    DOSAGE & INDICATIONS

    For pneumococcal prophylaxis.
    For routine immunization.
    Intramuscular dosage (PCV13 or Prevnar 13)
    Geriatric patients

    ACIP does not recommend PCV13 for geriatric patients. Vaccination with PCV20 or PCV15 (followed by a dose of PPSV23) is recommended in these patients. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Adults 18 to 64 years

    ACIP does not recommend pneumococcal vaccine for healthy adults. Vaccination is only recommended for adults with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Children and Adolescents 5 to 17 years at first dose

    ACIP does not include recommendations for pneumococcal vaccine for healthy children and adolescents 5 years and older. Vaccination is only recommended in patients with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Children 24 to 59 months of age at first dose

    0.5 mL IM as a single dose.[39165] [53026]

    Children 12 to 23 months of age at first dose

    0.5 mL IM for 2 doses administered at least 8 weeks apart.

    Infants 7 to 11 months of age at first dose

    0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 8 weeks.

    Infants 6 weeks to 6 months of age at first dose

    0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 8 weeks after the third dose.

    Intramuscular dosage (PCV15 or Vaxneuvance)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.

    Geriatric patients who previously received PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 18 to 64 years

    ACIP does not recommend pneumococcal vaccine for healthy adults. Vaccination is only recommended for adults with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Children and Adolescents 5 to 17 years at first dose

    ACIP does not include recommendations for pneumococcal vaccine for healthy children and adolescents 5 years and older. Vaccination is only recommended in patients with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Children 24 to 59 months of age at first dose

    0.5 mL IM as a single dose. Administer a single dose to children who have received an incomplete series of another pneumococcal conjugate vaccine. At least 8 weeks should elapse between receipt of the last dose of another pneumococcal conjugate vaccine and administration of Vaxneuvance.

    Children 12 to 23 months of age at first dose

    0.5 mL IM for 2 doses, separated by at least 8 weeks.

    Infants 7 to 11 months of age at first dose

    0.5 mL IM for 3 doses. Give the first 2 doses at least 4 weeks apart. The third dose should ideally be given after the first birthday, separated from the second dose by at least 8 weeks.

    Infants 6 weeks to 6 months of age at first dose

    0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 and 15 months of age and at least 8 weeks after the third dose. The 4-dose series initiated with a lower valency pneumococcal conjugate vaccine (i.e., PCV13) can be completed with Vaxneuvance.

    Intramuscular dosage (PCV20 or Prevnar 20)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated.

    Geriatric patients who previously received PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Geriatric patients who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Adults 18 to 64 years

    ACIP does not recommend pneumococcal vaccine for healthy adults. Vaccination is only recommended for adults with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM dose.

    Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23)
    Geriatric patients

    0.5 mL IM or subcutaneously as a single dose. If patient previously received a pneumococcal conjugate vaccine (PCV13, PCV15), administer at least 1 year after conjugate vaccine dose.

    Adults 50 to 64 years

    ACIP does not recommend pneumococcal vaccine for healthy adults. Vaccination is only recommended for adults with underlying medical conditions. The FDA-approved product labeling recommends a single 0.5 mL IM or subcutaneous dose.

    For invasive pneumococcal prophylaxis in patients with high-risk conditions such as chronic heart disease, chronic lung disease (e.g., asthma treated with high-dose oral corticosteroids), and diabetes mellitus.
    Intramuscular dosage (PCV13 or Prevnar 13)
    Children 2 to 5 years of age

    If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, a dose of PPSV23 is needed at least 8 weeks after the last PCV13 dose.

    Intramuscular dosage (PCV15 or Vaxneuvance)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later. These doses do not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Intramuscular dosage (PCV20 or Prevnar 20)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Geriatric patients who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated. This dose does not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23)
    Geriatric patients who received previous vaccination with PPSV23 and PCV13

    0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV13 dose. Geriatric patients who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.

    Geriatric patients who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV15 dose.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13

    0.5 mL IM or subcutaneously as a single dose at least 1 year after the last dose of PCV13. This should be followed by 1 dose at age 65 years or older and at least 5 years apart from first dose.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 1 year after PCV15 dose. These doses do not need to be repeated if given before age 65 years.

    Adults 18 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    Children and Adolescents 2 to 17 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    For invasive pneumococcal prophylaxis in patients with cerebrospinal fluid leak or cochlear implant.
    Intramuscular dosage (PCV13 or Prevnar 13)
    Adults 18 years who are PCV13-naive and PPSV23-naive

    0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23.

    Adults 18 years old who are PCV13-naive, but received previous vaccination with PPSV23

    0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose.

    Children and Adolescents 6 to 17 years who are PCV13-naive and PPSV23-naive

    0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23.

    Children and Adolescents 6 to 17 years who are PCV13-naive, but received previous vaccination with PPSV23


    0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose.

    Children 2 to 5 years

    If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart and at least 8 weeks after the last PCV13 dose. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, a dose of PPSV23 is needed at least 8 weeks after the last PCV13 dose.

    Intramuscular dosage (PCV15 or Vaxneuvance)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later. These doses do not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Intramuscular dosage (PCV20 or Prevnar 20)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Geriatric patients who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated. This dose does not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23)
    Geriatric patients who received previous vaccination with PPSV23 and PCV13

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV13 dose. Geriatric patients who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.

    Geriatric patients who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. This should be followed by 1 dose at age 65 years or older and at least 5 years apart from first dose.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. These doses do not need to be repeated if given before age 65 years.

    Adults 18 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    Children and Adolescents 2 to 17 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    For invasive pneumococcal prophylaxis in patients with immunocompromising conditions (i.e., sickle cell disease and other hemoglobinopathies, anatomic or functional asplenia, congenital or acquired immunodeficiency, HIV infection, chronic renal failure, nephrotic syndrome, malignant neoplasms, leukemias, lymphomas, Hodgkin disease, solid organ transplantation, multiple myeloma, iatrogenic immunosuppression from drug or radiation therapy).
    Intramuscular dosage (PCV13 or Prevnar 13)
    Adults 18 years who are PCV13-naive and PPSV23-naive

    0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years).

    55134

    Adults 18 years who received previous vaccination with PPSV23

    0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 and at least 8 weeks after a dose of PCV13 (Max: 2 doses of PPSV23 before age 65 years).

    Children and Adolescents 6 to 17 years who are PCV13-naive and PPSV23-naive

    0.5 mL IM as a single dose, followed at least 8 weeks later by a dose of PPSV23. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years).

    Children and Adolescents 6 to 17 years who received previous vaccination with PPSV23


    0.5 mL IM as a single dose at least 8 weeks after the last PPSV23 dose. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 and at least 8 weeks after a dose of PCV13 (Max: 2 doses of PPSV23 before age 65 years).

    Children 2 to 5 years


    If 3 doses of PCV13 were received previously, give one 0.5 mL dose IM at least 8 weeks after the last PCV13 dose. If less than 3 doses of PCV13 were received previously, give 2 doses at least 8 weeks apart. Children who have received a dose of PPSV23 should also receive the recommended PCV13 doses. If not previously received, 2 doses of PPSV23 are needed; first PPSV23 dose at least 8 weeks after the last PCV13 dose and second PPSV23 dose 5 years later.

    Intramuscular dosage (PCV15 or Vaxneuvance)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 8 weeks later. These doses do not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Intramuscular dosage (PCV20 or Prevnar 20)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least at least 1 year after receipt of PPSV23. No further doses are needed.

    Geriatric patients who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated. This dose does not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23)
    Geriatric patients who received previous vaccination with PPSV23 and PCV13

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV13 dose. Geriatric patients who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    Geriatric patients who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV13

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second PPSV23 vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after PCV15 dose. These doses do not need to be repeated if given before age 65 years. For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    Adults 18 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    Children and Adolescents 2 to 17 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13. A second vaccination is recommended 5 years after the first dose of PPSV23 (Max: 2 doses of PPSV23 before age 65 years). For patients with HIV and CD4 counts less than 200 cells/mm3, the PPSV23 can be offered; however, it may be beneficial to wait until the CD4 count increases to more than 200 cells/mm3.

    For invasive pneumococcal prophylaxis in patients with chronic liver disease, alcoholism, or cigarette smoking.
    Intramuscular dosage (PCV15 or Vaxneuvance)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose, followed by 1 dose of PPSV23 at least 1 year later. These doses do not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Intramuscular dosage (PCV20 or Prevnar 20)
    Geriatric patients who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated.

    Geriatric patients who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Geriatric patients who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Adults 19 to 64 years who have never received a pneumococcal vaccine or unknown vaccine history

    0.5 mL IM as a single dose. If PCV20 is used, a dose of PPSV23 is NOT indicated. This dose does not need to be repeated if given before age 65 years.

    Adults 19 to 64 years who received previous vaccination with PPSV23 but who have not received any pneumococcal conjugate vaccine (PCV13, PCV15, PCV20)

    0.5 mL IM as a single dose at least 1 year after receipt of PPSV23. No further doses are needed.

    Adults 19 to 64 years who received previous vaccination with PCV13 but with incomplete PPSV23 series

    0.5 mL IM as a single dose if PPSV23 is not available.

    Intramuscular or Subcutaneous dosage (PPSV23 or Pneumovax 23)
    Geriatric patients who received previous vaccination with PPSV23 and PCV13


    0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV13 dose. Patients who received original PPSV23 vaccination before age 65, should receive another PPSV23 dose at or after age 65 years if at least 5 years have elapsed since the previous dose.

    Geriatric patients who received previous vaccination with PCV15

     0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV15 dose.

    Adults 19 to 64 years who are PPSV23-naive and received previous vaccination with PCV13

    0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV13 dose. This should be followed by 1 dose at age 65 years or older and at least 5 years from previous dose.

    Adults 19 to 64 years who are PPSV23-naive who received previous vaccination with PCV15

    0.5 mL IM or subcutaneously as a single dose, given at least 1 year after PCV15 dose. These doses do not need to be repeated if given before age 65 years.

    Adults 18 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    Children and Adolescents 6 to 17 years who are PPSV23-naive

    0.5 mL IM or subcutaneously as a single dose at least 8 weeks after the last dose of PCV13.

    For otitis media prophylaxis in infants and children younger than 6 years.
    Intramuscular dosage (Prevnar 13 only)
    Children 24 to 71 months of age at first dose

    0.5 mL IM for 1 dose prior to the sixth birthday. The manufacturer recommends a single dose for patients 15 to 71 months of age whereas the ACIP recommends a single dose for all children 14 to 59 months of age and for all children 60 to 71 months of age with underlying medical conditions.

    Children 12 to 23 months of age at first dose

    0.5 mL IM for 2 doses administered at least 2 months apart.

    Infants 7 to 11 months of age at first dose

    0.5 mL IM for 3 doses. Give the first 2 doses 4 to 8 weeks apart. The third dose should ideally be given at 12 to 15 months; it must be separated from the second dose by 2 months or more and given after the first birthday.

    Infants 6 weeks to 6 months of age at first dose


    0.5 mL IM for a total of 4 doses. Give the first 3 doses at intervals of 4 to 8 weeks, ideally at 2, 4, and 6 months of age; the first dose can be given as young as 6 weeks. The fourth dose is given as a booster between 12 to 15 months of age and at least 8 weeks after the third dose.

    MAXIMUM DOSAGE

    Adults

    0.5 mL/dose IM for PCV13 (Prevnar 13), PCV20 (Prevnar 20), and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).

    Geriatric

    0.5 mL/dose IM for PCV13 (Prevnar 13), PCV20 (Prevnar 20), and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23).

    Adolescents

    0.5 mL/dose IM for PCV13 (Prevnar 13) and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23); safety and efficacy have not been established for PCV20 (Prevnar 20).

    Children

    2 to 12 years: 0.5 mL/dose IM for PCV13 (Prevnar 13) and PCV15 (Vaxneuvance); 0.5 mL/dose IM or subcutaneously for PPSV23 (Pneumovax 23); safety and efficacy have not been established for PCV20 (Prevnar 20).
    1 year: 0.5 mL/dose IM for PCV13 (Prevnar 13) and PCV15 (Vaxneuvance); safety and efficacy have not been established for PPSV23 (Pneumovax 23) and PCV20 (Prevnar 20).

    Infants

    6 weeks to 11 months: 0.5 mL/dose IM for PCV13 (Prevnar 13) and PCV15 (Vaxneuvance); safety and efficacy have not been established for PPSV23 (Pneumovax 23) and PCV20 (Prevnar 20).
    1 to 5 weeks: Use not recommended.

    Neonates

    Use not recommended.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

    Renal Impairment

    Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

    ADMINISTRATION

     
    Inform the patient, parent, guardian, or responsible adult of the benefits and risks of the vaccine. Provide the Vaccine Information Statements from the manufacturer to the recipient or guardian before each immunization. These actions are required by the National Childhood Vaccine Injury Act of 1986.
    Record the manufacturer and lot number of the vaccine; date of administration; and the name, address, and title of the person who administered the vaccine in the recipient's permanent medical record. These actions are required by the National Childhood Vaccine Injury Act of 1986.

    Injectable Administration

    Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
    Do not mix with any other vaccine.
    When concomitant administration of other vaccines or immunoglobulin is required, they should be given with different syringes and at different injection sites.

    Intramuscular Administration

    Preparation
    Use vaccine as supplied; reconstitution is not necessary.
    PCV13 (Prevnar 13) and PCV20 (Prevnar 20): Shake vigorously just prior to administration to obtain a homogenous, white suspension. Do not use the vaccine if it cannot be resuspended.
    PCV15 (Vaxneuvance): Shake vigorously just prior to administration to obtain an opalescent suspension. Do not use the vaccine if it cannot be resuspended.
    PPSV23 (Pneumovax 23): Pneumovax 23 is a clear solution that does not require shaking prior to administration.
     
    Intramuscular Injection
    For vials, use a sterile syringe and needle to withdraw the vaccine from the vial. For prefilled syringes, attach a sterile needle.
    Adults: Inject IM into the deltoid muscle or into the anterolateral thigh muscle.
    Pediatric patients: Inject IM into the anterolateral aspect of the mid-thigh (for infants younger than 1 year) or the deltoid muscle of the upper arm (usually suitable for older children). Do NOT administer in the gluteal muscle or other areas where there may be a major nerve trunk.

    Subcutaneous Administration

    Only PPSV23 (Pneumovax 23) is approved for subcutaneous administration.
    Use vaccine as supplied; reconstitution is not necessary. The vaccine is a clear solution.
    Use a sterile syringe and needle to withdraw solution from the vial.
    Inject subcutaneously into the outer aspect of the upper arm. Care should be taken to avoid intradermal injection.

    STORAGE

    Pneumovax 23:
    - Discard product if it contains particulate matter, is cloudy, or discolored
    - Store between 36 to 46 degrees F
    Prevnar:
    - Protect from freezing
    - Refrigerate (between 36 and 46 degrees F)
    Prevnar 13 :
    - Discard if product has been frozen
    - Do not freeze
    - Refrigerate (between 36 and 46 degrees F)
    Prevnar 20:
    - Discard if product has been frozen
    - Discard product if it contains particulate matter, is cloudy, or discolored
    - Do not freeze
    - Refrigerate (between 36 and 46 degrees F)
    - See package insert for detailed storage information
    VAXNEUVANCE:
    - Discard product if it contains particulate matter, is cloudy, or discolored
    - Do not freeze
    - Refrigerate (between 36 and 46 degrees F)
    - To protect from light, store syringe in original carton until time of use

    CONTRAINDICATIONS / PRECAUTIONS

    General Information

    Prior to administration, inform the patient, parent, guardian, or responsible adult of the benefits and risks of the vaccine, and provide the Vaccine Information Statement, accessible at the Centers for Disease Control and Prevention (CDC) website. These actions are required by the National Childhood Vaccine Injury Act of 1986. If a dose of pneumococcal vaccine, polyvalent has been previously given, question the parent or guardian about previous adverse reactions that may preclude further administration. Report all adverse reactions to the Vaccine Adverse Event Reporting System (VAERS), as well as the manufacturer. The toll-free number for VAERS is 1-800-822-7967. Educate the responsible adult(s) to promptly report any adverse reaction after vaccine administration to a health care provider.
     
    Pneumococcal vaccines are contraindicated in patients who have had a previous hypersensitivity reaction to the vaccine to be administered or to any components of the vaccine. PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20 (Prevnar 20) are contraindicated in patients who have had a hypersensitivity reaction to any diphtheria toxoid-containing vaccine. As with any biologic product, the prescriber or health care professional should have procedures in place to manage allergic reactions. The health care professional should have immediate availability of epinephrine (1 mg/mL) injection and other agents used in the treatment of severe anaphylaxis in the event of a serious allergic reaction to the pneumococcal vaccines.

    Intravenous administration, subcutaneous administration

    The conjugated pneumococcal vaccines (PCV13 [Prevnar 13], PCV15 [Vaxneuvance], or PCV20 [Prevnar 20]) are only indicated for intramuscular administration; do not give via intravenous administration, subcutaneous administration, or intradermal administration. PPSV23 (Pneumovax 23) may be administered via intramuscular or subcutaneous routes. Incorrect administration may result in inadequate immunity.

    Fever, infection

    The decision to administer or delay vaccination with the pneumococcal vaccine because of current or recent febrile illness depends on the severity of symptoms and on the etiology of the disease. The Advisory Committee on Immunization Practices recommends that vaccinations be delayed during the course of a moderate or severe acute illness with or without fever and administered after the acute phase of illness has resolved. All vaccines can be given to persons with minor illnesses such as diarrhea, mild upper-respiratory infection with or without low-grade fever, or other low-grade febrile illness.

    Immune thrombocytopenic purpura (ITP)

    Use pneumococcal vaccines with caution in patients with immune thrombocytopenic purpura (ITP) because pneumococcal vaccination has been associated with relapse of this condition in previously stabilized patients. Monitor patients for relapse after vaccination.

    Cardiac disease, pulmonary disease

    Use pneumococcal vaccines cautiously in patients with severe cardiac disease or pulmonary disease because systemic reactions may pose significant risks in these patient populations. In patients at higher risk for pneumococcal infection, including those with chronic heart or lung disease, diabetes mellitus, cochlear implants, or cerebrospinal fluid leaks (due to congential lesions, skull fractures, or neurosurgical procedures), give the pneumococcal vaccine in accordance with current immunization schedules. Pneumococcal meningitis may not be prevented with pneumococcal immunization in patients with cerebrospinal fluid leaks.

    Agammaglobulinemia, allogeneic stem cell transplant, chemotherapy, corticosteroid therapy, Hodgkin lymphoma, hypogammaglobulinemia, immunosuppression, leukemia, neoplastic disease, organ transplant, radiation therapy, renal failure, severe combined immunodeficiency (SCID), sickle cell disease

    Patients with significant immunosuppression may not have an adequate antibody response to pneumococcal vaccines. Immunosuppressed persons may include those with: absent or deficient splenic function (including sickle cell disease); severe combined immunodeficiency (SCID); hypogammaglobulinemia; agammaglobulinemia; chronic renal failure and nephrotic syndrome; allogeneic stem cell transplant; organ transplant; altered immune states due to generalized neoplastic disease (i.e., leukemia, lymphoma, Hodgkin lymphoma); or an immune system compromised by radiation therapy or drug therapy (e.g., chemotherapy or corticosteroid therapy with greater than physiologic doses). Short-term (less than 2 weeks) corticosteroid therapy or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive. In a study evaluating antibody response to the pneumococcal conjugate vaccine (PCV13) in pediatric patients with sickle cell disease, antipneumococcal opsonophagocytic activity (OPA) geometric mean antibody titers (GMTs) for all vaccine serotypes were higher than prevaccination concentrations after the first dose, and were generally comparable after subsequent doses. In patients (age 2 to 71 years) who received an allogeneic hematopoietic stem cell transplant 3 to 6 months prior to a series of PCV13 vaccines, sera was obtained approximately 1 month after each vaccination. Immune responses (IgG GMCs) were numerically higher after the first dose compared with baseline and were, similarly, numerically higher after each subsequent dose compared to the previous dose. Invasive pneumococcal disease has decreased substantially among pediatric patients with sickle cell disease since the introduction of PCVs; however, risk still remains higher compared to healthy patients. Patients with chronic immunodeficiency should receive PCV13 in addition to PPSV23 (23-valent pneumococcal polysaccharide vaccine) according to current immunization schedules. If elective splenectomy or immunosuppressive therapy is planned, complete necessary pneumococcal immunization at least 2 weeks before surgery or therapy initiation.

    Acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV) infection

    Compared to healthy individuals, patients with human immunodeficiency virus (HIV) infection generally have lower vaccine-induced antibody concentrations, which are proportional to the severity of infection (i.e., CD4 counts) and are lowest in those with acquired immunodeficiency syndrome (AIDS). The 13-valent pneumococcal conjugate vaccine (PCV13) may be administered to all persons with HIV, regardless of CD4 counts. In those who receive the PCV13 when the CD4 count is less than 200 cells/mm3, some experts may choose to defer the 23-valent pneumococcal polysaccharide vaccine (PPSV23) until CD4 counts are above 200 cells/mm3 in order to optimize vaccine efficacy. Vaccination is increasingly pertinent with the rising incidence of drug-resistant S. pneumoniae infections. In studies evaluating antibody response to the pneumococcal conjugate vaccine (PCV13) in pediatric patients and adults with HIV infection, antipneumococcal opsonophagocytic activity (OPA) geometric mean antibody titers (GMTs) for all vaccine serotypes were higher than prevaccination concentrations after the first dose, and were generally comparable after subsequent doses. In other studies involving pediatric patients with HIV, antibody response to various formulations of pneumococcal conjugate vaccines (PCV) have been slightly lower but comparable to patients who are not infected.

    Children, infants, neonates, premature neonates

    Safety and efficacy of the pneumococcal conjugate vaccine 13 (PCV13 or Prevnar 13) or pneumococcal conjugate vaccine 15 (PCV15 or Vaxneuvance) have not been established in neonates and infants younger than 6 weeks of age. Safety and efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23) have not been established in children younger than 2 years of age. Patients in this age group do not develop an effective immune response to the capsular types contained in this polysaccharide vaccine. Safety and efficacy of the pneumococcal conjugate vaccine 20 (PCV20 or Prevnar 20) have not been established in any pediatric patient. Apnea has occurred in some premature neonates and infants after intramuscular injections. The risks and benefits of intramuscular injections, including vaccination with the pneumococcal vaccine, must be considered on an individual patient basis. In addition, health care providers are advised that immunogenicity may be lower in premature neonates. In 1 study, premature neonates (younger than 37 weeks gestation; n = 100) receiving Prevnar 13 on a non-United States 4-dose schedule displayed lower serotype-specific IgG antibody responses after the third and fourth doses when compared to term neonates (37 weeks gestation and older; n = 100).

    Pregnancy

    Available data on pneumococcal vaccine administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy. No adequate and well-controlled studies have been conducted in pregnant women. No fetal malformations were noted after administration of pneumococcal conjugate vaccine 13 (PCV 13) at a dose approximately 20 times the human dose to rabbits prior to mating and during gestation. According to the Advisory Committee on Immunization Practices (ACIP), administration of inactivated vaccines to pregnant women has not resulted in adverse effects in the fetus. The ACIP recommends vaccination during pregnancy when the likelihood of disease exposure is high, potential infection would cause harm to mother or fetus, and when the vaccine is unlikely to cause harm.

    Breast-feeding

    Data are limited regarding use of the pneumococcal vaccine during breast-feeding and its excretion in human breast milk is unknown. According to the Advisory Committee on Immunization Practices (ACIP), inactivated vaccines pose no risk for mothers or their infants. Additionally, breast-feeding does not adversely affect immunization; limited data suggest breast-feeding may enhance the immune response to certain vaccine antigens. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.

    Anticoagulant therapy, coagulopathy, hemophilia, thrombocytopenia, vitamin K deficiency

    The pneumococcal vaccines are indicated for intramuscular (IM) administration. Therefore, administer with caution to persons receiving anticoagulant therapy. Also, monitor patients with thrombocytopenia, coagulopathy (e.g., hemophilia), other bleeding disorders, or vitamin K deficiency closely for bleeding at the IM injection site. Steps to avoid hematoma formation are recommended.

    ADVERSE REACTIONS

    Severe

    seizures / Delayed / 0-1.0
    bronchospasm / Rapid / 0-1.0
    skin necrosis / Early / Incidence not known
    hemolytic anemia / Delayed / Incidence not known
    aplastic anemia / Delayed / Incidence not known
    Guillain-Barre syndrome / Delayed / Incidence not known
    serum sickness / Delayed / Incidence not known
    erythema multiforme / Delayed / Incidence not known
    anaphylactic shock / Rapid / Incidence not known
    angioedema / Rapid / Incidence not known
    anaphylactoid reactions / Rapid / Incidence not known

    Moderate

    erythema / Early / 10.8-70.0
    dyspnea / Early / 0-1.0
    lymphadenopathy / Delayed / Incidence not known
    thrombocytopenia / Delayed / Incidence not known
    Arthus reaction / Early / Incidence not known
    hypotonia / Delayed / Incidence not known

    Mild

    irritability / Delayed / 14.3-85.6
    headache / Early / 15.9-81.4
    fatigue / Early / 13.2-80.5
    drowsiness / Early / 2.6-71.5
    myalgia / Early / 11.9-61.8
    anorexia / Delayed / 10.4-56.7
    insomnia / Early / 6.8-47.7
    chills / Rapid / 2.7-38.1
    fever / Early / 0.3-36.5
    arthralgia / Delayed / 7.7-31.5
    infection / Delayed / 0.5-2.6
    nausea / Early / 1.8-1.8
    pruritus / Rapid / 0.2-1.6
    ecchymosis / Delayed / 1.1-1.1
    dyspepsia / Early / 1.1-1.1
    pharyngitis / Delayed / 0.4-1.1
    urticaria / Rapid / 0-1.0
    back pain / Delayed / 0.9-0.9
    rash / Early / 1.0
    vomiting / Early / 0.9
    diarrhea / Early / 0.7
    malaise / Early / Incidence not known
    injection site reaction / Rapid / Incidence not known
    petechiae / Delayed / Incidence not known
    purpura / Delayed / Incidence not known
    leukocytosis / Delayed / Incidence not known
    paresthesias / Delayed / Incidence not known
    pallor / Early / Incidence not known
    dizziness / Early / Incidence not known
    syncope / Early / Incidence not known

    DRUG INTERACTIONS

    Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Aspirin: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen. (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Caffeine; Dihydrocodeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Caffeine; Pyrilamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine; Dextromethorphan: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine; Phenylephrine : (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Codeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan; Doxylamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dextromethorphan; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Dichloralphenazone; Isometheptene: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Diphenhydramine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Hydrocodone: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Pamabrom; Pyrilamine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Pentazocine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Propoxyphene: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Acetaminophen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Amlodipine; Celecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Butalbital; Caffeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Caffeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Caffeine; Dihydrocodeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Carisoprodol: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Dipyridamole: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Omeprazole: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Aspirin, ASA; Pravastatin: (Moderate) Concomitant administration of antipyretics, such as aspirin, ASA, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Benzhydrocodone; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Bupivacaine; Meloxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Butalbital; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Butalbital; Acetaminophen; Caffeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Celecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Celecoxib; Tramadol: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Diclofenac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Diclofenac; Misoprostol: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Diflunisal: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Diphenhydramine; Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Diphenhydramine; Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Etodolac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Fenoprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Flurbiprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Hydrocodone; Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ibuprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ibuprofen; Famotidine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ibuprofen; Oxycodone: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ibuprofen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Indomethacin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ketoprofen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ketorolac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Lansoprazole; Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Meclofenamate Sodium: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Mefenamic Acid: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Meloxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Nabumetone: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Naproxen; Esomeprazole: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Naproxen; Pseudoephedrine: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Nonsteroidal antiinflammatory drugs: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Ocrelizumab: (Moderate) Administer all non-live vaccines at least 2 weeks before ocrelizumab initiation, whenever possible. Ocrelizumab may interfere with the effectiveness of non-live virus vaccines. Attenuated antibody responses to tetanus toxoid-containing vaccine, pneumococcal polysaccharide and pneumococcal conjugate vaccines, and seasonal influenza vaccine were observed in patients exposed to ocrelizumab at the time of vaccination during an open-label study. Infants born to mothers exposed to ocrelizumab during pregnancy may receive non-live vaccines as indicated before B-cell recovery; however, consider assessing the immune response to the vaccine. ACIP recommends that patients receiving any vaccination during immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated a minimum of 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of, or in addition to, vaccination.
    Ofatumumab: (Major) Administer all needed non-live vaccines according to immunization guidelines at least 2 weeks before initiation of ofatumumab. Ofatumumab may interfere with the effectiveness of inactivated vaccines due to its actions, which cause B-cell depletion.
    Oxaprozin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Piroxicam: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Rofecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Satralizumab: (Major) Administer all non-live vaccines according to immunization guidelines at least 2 weeks before initiation of satralizumab.
    Siponimod: (Moderate) Administer all non-live vaccines at least 2 weeks before siponimod initiation, whenever possible. Vaccines may be less effective if given during siponimod treatment. Patients should be considered unimmunized if vaccinated within a 14-day period before starting immunosuppresive therapy or during immunosuppressive therapy, and should they be revaccinated at least 3 months after therapy is discontinued if immune competence is restored.
    Sulindac: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Sumatriptan; Naproxen: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Tolmetin: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Tramadol; Acetaminophen: (Moderate) Concomitant administration of antipyretics, such as acetaminophen, may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.
    Valdecoxib: (Moderate) Concomitant administration of antipyretics, such as nonsteroidal antiinflammatory drugs (NSAIDS), may decrease an individual's immunological response to the pneumococcal vaccine. A post-marketing study conducted in Poland using a non-US vaccination schedule (2, 3, 4, and 12 months of age) evaluated the impact of prophylactic oral acetaminophen on antibody responses to Prevnar 13. Data show that acetaminophen, given at the time of vaccination and then dosed at 6 to 8 hour intervals for 3 doses on a scheduled basis, reduced the antibody response to some serotypes after the third dose of Prevnar 13 when compared to the antibody responses of infants who only received antipyretics 'as needed' for treatment. However, reduced antibody responses were not observed after the fourth dose of Prevnar 13 with prophylactic acetaminophen.

    PREGNANCY AND LACTATION

    Pregnancy

    Available data on pneumococcal vaccine administered to pregnant women are insufficient to inform vaccine-associated risks in pregnancy. No adequate and well-controlled studies have been conducted in pregnant women. No fetal malformations were noted after administration of pneumococcal conjugate vaccine 13 (PCV 13) at a dose approximately 20 times the human dose to rabbits prior to mating and during gestation. According to the Advisory Committee on Immunization Practices (ACIP), administration of inactivated vaccines to pregnant women has not resulted in adverse effects in the fetus. The ACIP recommends vaccination during pregnancy when the likelihood of disease exposure is high, potential infection would cause harm to mother or fetus, and when the vaccine is unlikely to cause harm.

    Data are limited regarding use of the pneumococcal vaccine during breast-feeding and its excretion in human breast milk is unknown. According to the Advisory Committee on Immunization Practices (ACIP), inactivated vaccines pose no risk for mothers or their infants. Additionally, breast-feeding does not adversely affect immunization; limited data suggest breast-feeding may enhance the immune response to certain vaccine antigens. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.

    MECHANISM OF ACTION

    The high virulence of the pneumococcal organism is largely due to its polysaccharide capsule, which inhibits phagocytosis by white blood cells. There are at least 90 known pneumococcal capsular types. The preponderance of pneumococcal disease, however, is caused by only a minority of these 90 types. Surveillance data revealed that 56% of all deaths due to pneumococcal pneumonia at a New York medical center from 1952 to 1962 were caused by only 6 different capsular types and that 78% of all pneumococcal pneumonias were caused by 12 capsular types. A similar pattern has been demonstrated throughout the world.
     
    Non-conjugate pneumococcal vaccine, polyvalent: Non-conjugated polyvalent pneumococcal vaccines (Pneumovax 23) contain the capsular polysaccharides from the 23 most virulent and common strains of pneumococcus. The vaccines include the 6 most-commonly virulent serotypes: 6B, 9V, 14, 19A, 19F, and 23F. These 23 antigens represent roughly 90% of the reported types associated with clinical infection. Studies in humans have demonstrated the immunogenicity of each of the 23 antigens when tested in polyvalent vaccines; although, some of the serotypes are reported to be poor immunogens. Non-conjugated polysaccharide vaccines stimulate a T-cell independent immune response. Vaccine exposure stimulates the immune system to produce pneumococcal capsule-specific antibodies that make the organism more vulnerable to phagocytosis and other host-defenses. The antibody produced by these vaccines is primarily IgM, which affects vaccine efficacy. They do not induce T-cell dependent responses associated with immunologic memory. After revaccination, antibody titers increase, but an anamnestic response does not occur. Clinical trials suggest a protective efficacy of 60% to 90%.
     
    Conjugated pneumococcal vaccine: Prevnar 13 is a 13-valent conjugate vaccine that contains 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F). Serotype 1 has been reported to be the most common cause of pneumococcal empyema (24% to 50% of cases), and serotype 19A is reported to be the most common cause of invasive pneumococcal disease since the introduction of Prevnar into the childhood immunization series. Vaxneuvance is a 15-valent conjugate vaccine that contains 15 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F). Prevnar 20 is a 20-valent conjugate vaccine that contains 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F).
     
    The polysaccharides of the pneumococcal serotypes are bound to a non-toxic diphtheria protein known as CRM197. By coupling the polysaccharides to this carrier protein, a T-cell dependent immune response is generated. The conjugated polysaccharide (antigen) can then be presented by major histocompatibility complex molecules, which signals the activation of T-helper cells. The T-helper cells are then able to stimulate B-cells to mature into antibody-secreting plasma or memory cells. The exposure to the vaccine produces pneumococcal capsule-specific antibodies that make the organism more vulnerable to phagocytosis and other host-defenses.

    PHARMACOKINETICS

    Pneumococcal vaccine is administered intramuscularly. The PPSV23 (Pneumovax 23) formulation of the vaccine may also be administered subcutaneously. The distribution, metabolism, and excretion of the vaccines have not been well-defined. The immunologic response and duration of immunity conferred by pneumococcal vaccine is dependent upon the serotypes present in the vaccine and whether the polysaccharides are coupled/conjugated to various carrier proteins. In some individuals, immune response to the vaccine may not be sufficient to prevent pneumococcal infection.
     
    PCV13 (Prevnar 13): Patients who received Pneumovax 23 within 1 year prior to Prevnar 13 receipt experienced diminished immune responses to Prevnar 13 compared to Pneumovax 23 naive individuals.
    PCV15 (Vaxneuvance): Immune response to Vaxneuvance was similar to that seen after Prevnar 13 administration in clinical studies, including patients administered Pneumovax 23 six months to 1 year after Vaxneuvance or Prevnar 13.
    PCV20 (Prevnar 20): Patients who received Pneumovax 23 within 1 to 5 years prior to Prevnar 20 receipt experienced diminished immune responses to Prevnar 20 compared to patients who received Prevnar 13 at least 6 months prior and compared to patients who received Prevnar 13 followed by Pneumovax 23, with the last dose of Pneumovax 23 given at least 1 year prior to Prevnar 20.
    PPSV (Pneumovax 23): Immunity after injection occurs in 2 to 3 weeks. Antibodies against the vaccine serotypes develop in more than 80% of vaccinated healthy adults; older adults and patients with chronic illness or immunodeficiency may not respond well. Serotype-specific antibodies decline after 5 to 10 years; however, the rate of decline varies depending on the patient population. In healthy adults, increased antibody concentrations exist for at least 5 years. Data from 1 epidemiologic study suggest vaccination may provide protection for at least 9 years after the initial dose in adults; however, the correlation between serology and clinical protection is not firm. There is some evidence that revaccination can raise antibody concentrations and can ensure life-long immunity without significantly increasing the risk of adverse reactions. Revaccination is recommended for certain patients, such as those with immunosuppression.