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Pediatrics/Prevenar 13 vaccination- further cllarification


Dear Sir,
Thanx Doc for your valuable reply to my query dated 30/12/2012 on Vaccination.
In this regard I have few more queries.
My son has already been administered with two shots of Synflorix at 7th & 11 th week and one dose of Prevenar 13 at 15th week respectively.

As per schedule only 3 doses of PCV to be administered within 12 months of age.

a) As such whether administering further with either 2 doses of prevenar 13  at 19 th week and 23rd week respectively, would not lead to over dose of Pneomoccocal Conjugate vaccine.

b)Furthermore , as My son has already been administered with one  Prevenar 13, what will be risk involved in switching again to synflorix?

c) What will be the safest  and the best course of action i.e. whether I should go for additional 2 shots of Prevenar 13 or one shot of Synflorix
Also accordingly, in your opinion what will be best PCV as booster dose.

Sir, I am very confuse in this regard.
I will be grateful to you, for your valuable advise.

Sanak Das
d) one dose of Synflorix ( both other than the schedule for

Question asked on 30/12/2012

I have blessed with a boy on 29/08/2012
His vaccinations till date is as folows-
30/08/2012    BCG+Hep B+ HIB
02/10/2012    Enjerix B (Hep B)
15/10/2012    Pentaxim + Rotateq+ OPV
20/10/2012    Synflorix
16/11/2012    Pentaxim + Rotateq+ OPV
20/11/2012    Synflorix
20/12/2012    Pentaxim + Rotateq+ OPV+ Prevenar 13 (With a doctor other than previous one)         
a) Can we Synflorix interchanged with Prevenar?
   if yes, then what will be the further schedule of PCV
If No, then what to do next 9 as we have already administered)

b) Risk involved in administering Pentaxim + Rotateq+ OPV  and synflorix with agap of 5 days

Sanak Das

Answer on 31/12/2012

Hi Sanak,

I think the first vaccines must have been BCG+Hep B+ OPV (Hib is started only after 6 weeks of age)

Here are the answers:

(a) No, Synflorix can't be interchanged with Prevenar 13.

If Prevenar needs to be given, then full course (3 doses at 1 month interval followed by booster at 12-15 months of age need to be given.

Otherwise, One dose of Synflorix should be taken as soon as possible (It is already more than one month from 2nd dose) followed by booster at 12-15 months of age.

(b) There is no risk/ no problem in this. However, Pentaxim and Synflorix (along with Rotateq) could have been given on single day: That way number of visits to the doctor could have been reduced and number of "uncomfortable days" for the baby could have been reduced from six to three)

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India


Hi Sanak,

It can be authoritatively stated that Synflorix and Prevenar 13 are not interchangeable.

However, nobody can say it with authority what is the best course in such a case: 2 doses of Prevenar 13 or one dose of Synflorix, as there are no scientific studies which can show what is better. Nevertheless, based on knowledge on basic immunology, my personal view would be to go for 2 doses of Prevenar 13 if cost is not the constraint, as it is a better vaccine. Otherwise, you can also go for one shot of Synflorix. More number of doses of a vaccine does not usually have any deleterious effects (except extra pricks and extra cost).

The booster at 12-15 months should be of the same brand whose 3 doses are given in first year.

Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India



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Dr. Puneet Kumar


I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query that requires diagnosing, since it is not possible to examine a child online.


I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 17 years of experience in the field.

Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (

(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. (f) Regular column, “How do I treat” in Pediascene ( (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 ( ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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