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In 2002, the Chief Medical Officer advised that children under 2 years of age at risk of invasive pneumococcal disease should receive three doses of Prevenar with their primary immunisations followed by a booster in the second year of life.3 Many of these infants start their immunisations on neonatal units. In our centre, infants complete their primary course, but not the booster dose. We surveyed 73 United Kingdom neonatal intensive care units to determine Prevenar usage.
Of the 58 (79%) units that replied, 26 (45%) routinely recommend Prevenar vaccination to some or all of their “at risk” patients (table 1). These units immunise a median of 15 infants per year (interquartile range 5–20).
There was no significant difference in size, by number of intensive care cots, between neonatal units that recommend Prevenar and those that do not.
Seventeen units recommend a primary course of three immunisations. The other units recommend one, two, or five doses. Twelve recommend a booster in the second year of life; no units thought that all of their patients were receiving that dose.
Of the units reporting problems with immunisation administration, four found that general practitioners were reluctant to administer Prevenar; the remaining unit had observed adverse effects in one patient. No units were checking vaccine responses.
Our survey indicates that many infants in the United Kingdom at risk of invasive pneumococcal disease are not adequately immunised despite recent recommendations. Infants with chronic lung disease are immunised in only 23 (40%) of the responding neonatal intensive care units.
The most common reason for not recommending conjugate pneumococcal vaccine to patients is the lack of evidence of benefit in a neonatal intensive care population (table 1). Although the Kaiser Permanente subanalysis of preterm and low birthweight infants immunised at 2, 4, and 6 months of age found Prevenar to be immunogenic, all of these infants had been discharged from the neonatal unit before vaccination, thus excluding the most preterm infants.4 A United Kingdom immunogenicity study of vaccination at 2, 3, and 4 months of age excluded preterm infants and did not include all vaccines in the current immunisation schedule.5 There is therefore no evidence to indicate that preterm infants vaccinated according to the current United Kingdom primary immunisation schedule benefit from the administration of conjugate pneumococcal vaccine, and further studies are required to address this.
Competing interests: none declared
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