See section 1.4 for general contraindications for all vaccines. There are no speciﬁc contraindications to pneumococcal polysaccharide or conjugate vaccines apart from a severe reaction to a previous dose or known hypersensitivity to any components of either vaccine.
Systemic reactions (chills, rash and myalgia) may occur when PCV13 and influenza vaccine are administered at the same time (see section 15.7.2). PCV13 has been associated with increased risk of fever over 39℃ and febrile convulsions when co-administered with inactivated influenza vaccine in infants and young children (see section 15.7.2). Febrile convulsion history is not a contraindication to PCV13 immunisation. Parents/guardians can be encouraged to use cooling measures and/or antipyretics (see section 2.3.13) if a child with a history of febrile convulsions develops a fever after immunisation. If a child aged under 5 years needs both PCV13 and influenza vaccines, separation of vaccines by two days can be offered. If the child has a history of febrile convulsions, separation of the vaccines is recommended.
Following an analysis of post-marketing reporting rates, there is a potential increased risk of convulsions (with or without fever) and hypotonic-hyporesponsive episodes when co-administering DTaP-IPV-HepB/Hib (Infanrix-hexa) and PCV13 compared to the use of DTaP-IPV-HepB/Hib alone.47–51 (See section 15.7.2.)
PCV13 should be used with caution in very premature babies (born at under 28 weeks’ gestation) as there is a potential risk for apnoea. If a preterm infant had apnoeas following immunisation in hospital (6 week and/or 3-month event), readmission for the next infant immunisation and respiratory monitoring for 48 to 72 hours may be warranted,55 but do not avoid or delay immunisation.
23PPV should not be given to children aged under 2 years due to the reduced immune response associated with polysaccharide vaccines (see section 1.2.3).