New pneumococcal polysaccharide conjugate vaccine (Synflorix) added to the national immunisation schedule

Routine use of paracetamol at the time of vaccination is no longer recommended.4 However, a prophylactic antipyretic is recommended when administering pneumococcal vaccines to children with seizure disorders or with a prior history of febrile seizures.5,6

Paracetamol can be given after vaccination if an infant or child has a fever of > 38.5ºC. The dose is 15 mg/kg paracetamol liquid, up to a maximum daily dose of 90 mg/kg/day in 4–6 divided doses for up to 48 hours.4

Clinical trial data suggest that using prophylactic paracetamol might reduce the immune response to conjugate pneumococcal vaccines and some other paediatric vaccines, although it is unknown if the reduction is clinically relevant.1,7,8 An effect on antibody concentrations has been seen with both the 10-valent vaccine (Synflorix) and the 7-valent vaccine (Prevenar).7,8 Other antipyretics, such as ibuprofen, may have a similar effect, but there are no data.

Infants who received prophylactic paracetamol in 1 trial had lower antibody concentrations after the primary vaccination with the 10-valent vaccine than infants who did not receive paracetamol. The difference in antibody concentrations was larger for some serotypes than for others.7,8

The significance of the lower post-primary antibody response is unclear, but the data from 12–15 months after the booster dose suggest that any impact on efficacy should be limited. After receiving booster doses, similar proportions of children achieved target levels of anti-pneumococcal antibodies, regardless of whether they received paracetamol (with the exception of 1 measure of response to serotype 6B).7,8

Please note that this web version was updated after the December 2009 issue of NPS RADAR was printed. It contains more information from the PBAC Public Summary Document about the timing of the booster dose.