pneumococcal vaccine

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Indications

vaccine serotypes for which protection afforded
PCV13 Block-1
PCV15 Block-1 + Block-2
PCV20 Block-1 + Block-2 + Block-3
PPSV23 Block-1 + Block-2 + Block-3 + Block-4 (except 6A in Block-1)

Block-1: serotypes: 1, 2, 3, 4, 5, 6A, 6B, 7F,14, 18C, 19A, 19F, 23F

Block-2: serotypes: 22F, 33F

Block-3: serotypes: 8, 10A, 11A, 12F, 15B

Block-4: serotypes: 2, 9N, 17F, 20

Contraindications

Management

Vaccination schedule for PCV13 recipients[10]

prior vaccination vaccines needed
PCV13 + PPSV23 PCV20 >= 5 years after previous dose
PCV13 only & healthy PPSV23 or PCV20 at age 65
PCV13 only & immunocompromised PPSV23 or PCV20 & repeat at age 65

* at least 1 year between vaccines

  • older adults who have not previously received either vaccine should be given one dose of Prevnar (PCV15) followed by one dose of Pneumovax (PPSV23) 1 year later (CDC)[7]
    • interval beween doses may be shortened to 8 weeks if high immediate risk
    • do not give PCV13 to older adults
    • Prevnar (PCV20) is alternative to Prevnar (PCV15) + Pneumovax (PPSV23)
  • adults who have previously received Pneumovax should be given one dose of Prevnar (PCV15) or PCV20 at least 1 year after the last Pneumovax dose
  • if a patient received both PCV13 + PPSV23 before age 65, PCV20 should be adminisered 5 years later
  • if patient received either (PCV13 or PSV15) or PPSV23 before age 65, but not both, PCV20 may be administered after 1 year
  • PCV20 may be administered to patients who have received PCV13 at any age & PPSV23 at age >= 65 years (5 years after PPSV23)
  • if a patient received a PPSV23 dose before age 65, a 2nd dose should be administered 5 years later if Prevnar is not administered
    • do not give PCV13
      • no longer recommended because the risk of PCV13 serotype is lower in adults >= 65 because of decreased carriage & transmission from children
    • PCV13 is expensive & unnecessary for healthy elderly[5]
    • PCV13 use was associated with reduced pneumonia hospitalization among Medicare beneficiaries >= 65 years[11]
      • this would seem to implicate S pneumoniae serotype 6A (the only serotype not covered by PPSV23)
    • in adults 65-74 years adjusted vaccine effectiveness (aVE) of PCV13 alone for preventing pneumococcal CAP is 66%, for PPSV23 alone, aVE is 18.5%, & for sequential PCV13/PPSV23 aVE is 80%[6];
    • previous guidelines in 2021 recommended use of PPSV23 alone (2 doses) or PCV13 followed by PPSV23[16]

* PSV15 & PSV20 replace PSV13 in 2022[7]

* both PSV15 & PPSV23 recommended for immunocompromised patients & immunocompetent patients < 65 years of age who qualify[4][7]

* PSV20 recommended for immunocompetent patients < 65 years of age[4]

More general terms

More specific terms

References

  1. ↑ Centers for Disease Control & Prevention Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR October 12, 2012 / 61(40);816-819 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm
  2. ↑ 2.0 2.1 Tomczyk S et al Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >= 65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 19, 2014 / 63(37);822-825 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25233284 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm
  3. ↑ 3.0 3.1 Kobayashi M et al Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Weekly. September 4, 2015 / 64(34);944-947 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm
  4. ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. Board Basics. An Enhancement to MKSAP19. 2023 American College of Physicians, Philadelphia 2015, 2018, 20219.
  5. ↑ 5.0 5.1 Zuger A How Should We Use Conjugate Pneumococcal Vaccine in Immunocompetent Older Adults? NEJM Journal Watch. Jukt 25, 2019 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  6. ↑ 6.0 6.1 Heo JY, Seo YB, Choi WS et al. Effectiveness of pneumococcal vaccination against hospitalized pneumococcal pneumonia in older adults: A prospective, test-negative study. J Infect Dis 2021 Sep 19; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34537847 https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiab474/6372439
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Melville NA CDC Issues New Pneumococcal Vaccine Recommendations for Adults. Medscape. Feb 1, 2022
    Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109-117 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35085226 Free article https://www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm
    Centers for Disease Control and Prevention. Pneumococcal vaccination: Information for healthcare professionals. CDC 2022 Jan 24 https://www.cdc.gov/vaccines/vpd/pneumo/hcp/index.html
  8. ↑ 8.0 8.1 8.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  9. ↑ 9.0 9.1 Matanock A, Lee G, Gierke R, et al. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >=65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:1069-1075 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31751323 PMCID: PMC6871896 Free PMC article
  10. ↑ 10.0 10.1 Sax PE Five Quick Questions from Our Course " ID in Primary Care" HIV and ID Observations. Nov 7, 2022 https://blogs.jwatch.org/hiv-id-observations/index.php/five-quick-questions-from-our-course-id-in-primary-care/2022/11/07/
  11. ↑ 11.0 11.1 Kobayashi M et al. Association of pneumococcal conjugate vaccine use with hospitalized pneumonia in Medicare beneficiaries 65 years or older with and without medical conditions, 2014 to 2017. JAMA Intern Med 2023 Jan; 183:40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36469350 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799225
  12. ↑ 12.0 12.1 From The Medical Letter on Drugs and Therapeutics. December 28, 2021 Two New Pneumococcal Vaccines - Prevnar 20 and Vaxneuvance JAMA. 2021;326(24):2521-2522. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34962532 https://jamanetwork.com/journals/jama/fullarticle/2787554
  13. ↑ 13.0 13.1 Douros A et al. Common vaccines and the risk of incident dementia: A population-based cohort study. J Infect Dis 2022 Dec 21; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36542511 https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiac484/6948438
    Salmon DA et al. Commentary on "Common vaccines and the risk of dementia: a population-based cohort study": Science can be messy but eventually leads to truths. J Infect Dis 2022 Dec 21; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/36542509 https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiac487/6950650
  14. ↑ Prevnar20 https://prevnar20adult.pfizerpro.com/acip-recommendations
  15. ↑ Centers for Disease Control & Prevention Public Health Surveillance. September 29, 2023 2016-2021 Serotype Data for Invasive Pneumococcal Disease Cases by Age Group from Active Bacterial Core surveillance https://data.cdc.gov/Public-Health-Surveillance/2016-2021-Serotype-Data-for-Invasive-Pneumococcal-/qvzb-qs6p
  16. ↑ 16.0 16.1 Kobayashi M, Pilishvili T, Farrar JL et al. Pneumococcal vaccine for adults aged >= 19 years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023 Sep 8;72(3):1-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37669242 PMCID: PMC10495181 Free PMC article. https://www.cdc.gov/mmwr/volumes/72/rr/rr7203a1.htm
  17. ↑ 17.0 17.1 Ellis R FDA Approves New Pneumococcal Vaccine. Medscape. June 18, 2023 https://www.medscape.com/viewarticle/fda-approves-new-pneumococcal-vaccine-2024a1000bcm
  18. ↑ 18.0 18.1 Nakafero G et al. Effectiveness of pneumococcal vaccination in adults with common immune-mediated inflammatory diseases in the UK: A case-control study. Lancet Rheumatol 2024 Sep; 6:e615. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39067457 Free article https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(24)00128-0/fulltext
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