pneumococcal congugate vaccine (Prevnar, Prevnar 13, PCV13, Prevnar-20, PCV20, Prevnar-15, PCV15, Vaxneuvance, Capavaxive, PCV21, PHiD-CV10, PCV10, Synflorix)
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Introduction
Tradenames:
- PCV10 = Synflorix
- PCV15 = Vaxneuvance
- PCV20 = Prevnar (Pfizer)
- PCV21 = Capvaxive (Merk)[43]
* PCV13 no longer available[42]
Indications
- vaccination at 2, 4, 6 & 12-15 months for all children 23 months & younger - 2 doses may be equally effective[8]
- all children 23 months & younger who have not received doses of the vaccine should be given catch up doses
- the vaccine may be administered concurrently with other childhood immunizations
- children 24-59 months of age with high-risk conditions
- sickle cell disease
- splenic abnormalities
- HIV infection
- primary immunodeficiency
- immunosuppressive therapy
- all immunodeficient children 6-18 years of age regardless of prior vaccination with pneumococcal polysaccharide vaccine[15]
- approved for use in adults aged >=50 and older to prevent pneumonia & invasive disease caused by S pneumoniae[12];
- CDC's Advisory Committee on Immunization Practices (ACIP) recommends
- for all adults >= 65 years[13][21][23]
- Prevnar-13 prior to this recommended for at risk seniors
- immunosuppression, CSF leak, or cochlear implant[37]
- long-term care residemts[37]
- protects against otitis media in children[32]
- infant pneumococcal conjugate vaccine in Kenya was followed by a decrease in vaccine-type invasive pneumococcal disease in all age groups[33]
- 13-valent pneumococcal conjugate vaccine during childhood reduced incidence of invasive pneumococcal disease in adults[35]
- PCV13 is expensive & unnecessary for healthy elderly[36][38]
- Table: PCV20 coverage & serotype frequency for years 2020 & 2021[42]
| serotype | 2020 | 2021 | |
|---|---|---|---|
| 1* | 0 | 0 | |
| 10A* | 16 | 5 | |
| 11A* | 26 | 16 | |
| 12F* | 6 | 7 | |
| 13 | 1 | 3 | |
| 14* | 3 | 0 | |
| 15A | 26 | 32 | |
| 15B* | 11 | 10 | |
| 15C | 9 | 3 | |
| 16F | 22 | 23 | |
| 17F | 3 | 2 | |
| 18C* | 0 | 2 | |
| 19A* | 18 | 11 | |
| 19F* | 15 | 14 | |
| 20 | 15 | 11 | |
| 21 | 1 | 1 | |
| 22F* | 58 | 40 | |
| 23A | 23 | 38 | |
| 23B | 12 | 11 | |
| 23F* | 1 | 0 | |
| 24F | 1 | 0 | |
| 28A | 1 | 3 | |
| 3* | 106 | 63 | |
| 31 | 12 | 12 | |
| 33F* | 12 | 14 | |
| 34 | 9 | 7 | |
| 35B | 29 | 43 | |
| 35F | 10 | 21 | |
| 37 | 1 | 0 | |
| 38 | 3 | 0 | |
| 4* | 7 | 8 | |
| 5* | 0 | 0 | |
| 6A* | 0 | 0 | |
| 6B* | 0 | 2 | |
| 6C | 12 | 8 | |
| 7C | 14 | 13 | |
| 7F* | 4 | 1 | |
| 8* | 18 | 8 | |
| 9N | 32 | 35 | |
| 9V* | 1 | 0 | |
| mixed | 122 | 142 | |
| NT | 3 | 0 |
* serotype covered by PCV20 , mixed = mixed serotypes
Contraindications
- not approved for use in children < 2 years of age
- not recommended for adults with COPD < 65 years of age[28]
- in 2019 PCV20 provided coverage for 47% of circulating strains (see table above in Indications)
Benefit/risk
- number needed to treat to prevent one hospitalization in Tennessee children = 667[22]
- Streptococcus pneumoniae isolated in 24% of PCV13-vaccinated children with otitis media[32]
- number needed to treat to prevent 1 case of invasive pneumococcal disease in the elderly is ~ 26,000 annually[36]
Dosage
- Prevnar-13 available in single-dose, pre-filled syringes
- PCV20 (Prevnar-20) or PCV15 (Vaxneuvance) available[39]
- PHiD-CV10, Synflorix (10 valent) at age 6 weeks to 18 months[14] (marketed in Europe)
- adults who have not previously received either vaccine should be given one dose of Prevnar followed by one dose of Pneumovax 1 year later (CDC)[24]
- adults who have previously received Pneumovax should be given one dose of Prevnar 1 year after the last Pneumovax dose
- serologic response to PCV13 significantly decreased after immunization with PPSV23[28]
Adverse effects
- febrile seizures 0.014% (0.045% when coadministered with parenteral influenza virus vaccine)[19]
Mechanism of action
- effective for prevention of pneumococcal meningitis
- reduces incidence of otitis media[3]
- at least 3 vaccinations required for sustained benefit
- 7% reduction in office visits for otitis media in 1st year of life
- 24% reduction in tympanostomy
- 35% fewer antibiotic prescriptions
- reduces bacteremia/sepsis due to pneumococcus[5][20]
- more immunogenic than PPS23 90% vs 60-70% effective[28]
- 26% reduction in pneumococcal meningitis after introduction of PCV13 (74% reduction of meningitis to susceptible serotypes)[18]
- reduces risk of non-bacteremic community-acquired pneumonia due to Streptococcus pneumoniae resistant to Pneumovax by 45%
- reduces incidence of viral pneumonia[6]
- reduces nasopharygeal carrier rate in children[10]
- PHiD-CV10, Synflorix contains 10 serotype-specific polysaccharides conjugated to Haemophilus influenzae protein D, tetanus toxoid, & diphtheria toxoid carriers
Notes
- Pneumovax is not sufficiently immunogenic in young children & is not approved for use in children < 2 years of age
- $136 per injection[21]
- for NNT of 667, this is $90,000/hospitalization
- PCV13 vaccines have reduced incidence of bacteremia in young children & shifted the most-commonly isolated pathogens from pneumococcus to E coli, S aureus, & Salmonella[30]
- 32% of seniors have received at least one PCV13 dose[31]
More general terms
More specific terms
Additional terms
- pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23, PPSV-23)
- Streptococcus pneumoniae (pneumococcus)
References
- ↑ Journal Watch 20(20):163, 2000
- ↑ Journal Watch 22(3):24, 2002 Black et al, Pediatr Infect D J 20:1105, 2001
- ↑ 3.0 3.1 Journal Watch 23(6):51, 2003 Fireman B et al, Pediatr Infect Dis J 22:10, 2003
- ↑ Journal Watch 24(15):122, 2004 Black S, Shinefield H, Baxter R, Austrian R, Bracken L, Hansen J, Lewis E, Fireman B. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatr Infect Dis J. 2004 Jun;23(6):485-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15194827
- ↑ 5.0 5.1 Journal Watch 24(16):128, 2004 Stoll ML, Rubin LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine: a study from a Children's Hospital Emergency Department and Urgent Care Center. Arch Pediatr Adolesc Med. 2004 Jul;158(7):671-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15237067
- ↑ 6.0 6.1 Journal Watch 24(17):138, 2004 Madhi SA, Klugman KP, The Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med. 2004 Aug;10(8):811-3. Epub 2004 Jul 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15247911
- ↑ Prescriber's Letter 13(5): 2006 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220620&pb=PRL Benefits of pneumococcal vaccine (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 Whitney CG et al, Effectiveness of seven-valent pneumococcal conjugate vaccinee against invasive pneumococcal disease: A matched case-control study. Lancet 2006, 368:1495 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17071283
- ↑ Centers for Disease Control (CDC) Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in Children Aged 24--59 Months Who Are Not Completely Vaccinated MMWR April 4, 2008 / 57(13);343-344 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5713a4.htm
- ↑ 10.0 10.1 van Gils EJM et al Effect of reduced-dose schedules with 7-valent pneumococcal conjugate vaccine on nasopharyngeal pneumococcal carriage in children: A randomized controlled trial. JAMA 2009 Jul 8; 302:159. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19584345
- ↑ FDA NEWS RELEASE: February 24, 2010 FDA Approves Pneumococcal Disease Vaccine with Broader Protection http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm201758.htm http://bit.ly/pa201003242a
- ↑ 12.0 12.1 FDA News & Events: Dec 30, 2011 FDA expands use of Prevnar 13 vaccine for people ages 50 and older http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm285431.htm
- ↑ 13.0 13.1 Department of Health and Human Services/Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices (ACIP). Summary report, February 22-23, 2012 [meeting minutes]. Atlanta, GA http://www.cdc.gov/vaccines/recs/acip/downloads/min-feb12.pdf
- ↑ 14.0 14.1 Palmu AA Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial. The Lancet, Early Online Publication, 16 November 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23158882 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61854-6/abstract
- ↑ 15.0 15.1 Centers for Disease Control and Prevention (CDC) Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6-18 Years with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 28, 2013 / 62(25);521-524 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6225a3.htm
- ↑ Griffin MR et al. U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med 2013 Jul 11; 369:155 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23841730 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1209165
- ↑ Spijkerman J et al Immunogenicity of 13-Valent Pneumococcal Conjugate Vaccine Administered According to 4 Different Primary Immunization Schedules in Infants. A Randomized Clinical Trial. JAMA. 2013;310(9):930-937. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24002279 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1734703
O'Brien KL Optimizing the Use of Pneumococcal Conjugate Vaccine Globally JAMA. 2013;310(9):911-913 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24002275 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1734679 - ↑ 18.0 18.1 Stockmann C et al. Pneumococcal meningitis in children: Epidemiology, serotypes, and outcomes from 1997 - 2010 in Utah. Pediatrics 2013 Sep; 132:421 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23979090 <Internet> http://pediatrics.aappublications.org/content/132/3/421
- ↑ 19.0 19.1 Maglione MA et al Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review. Pediatrics; published online July 1, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25086160 <Internet> http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1079.full.pdf+html
Byington CL Vaccines: Can Transparency Increase Confidence and Reduce Hesitancy? Pediatrics; published online July 1, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25086161 <Internet> http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1494.full.pdf+html - ↑ 20.0 20.1 Iroh Tam PY et al. Invasive pneumococcal disease after implementation of 13-valent conjugate vaccine. Pediatrics 2014 Jul 7 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25002663 <Internet> http://pediatrics.aappublications.org/content/early/2014/07/01/peds.2014-0473
- ↑ 21.0 21.1 21.2 Sofair A and Chavey E ACIP Recommends 13-Valent Pneumococcal Vaccine for Elders Physician's First Watch, Aug 15, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 22.0 22.1 Griffin MR et al Declines in Pneumonia Hospitalizations of Children Aged <2 Years Associated with the Use of Pneumococcal Conjugate Vaccines - Tennessee, 1998-2012 MMWR. Weekly. November 7, 2014 / 63(44);995-998 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6344a3.htm
- ↑ 23.0 23.1 Kim DK et al Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2015* Ann Intern Med. 2015;162(3):214-223 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25643306 <Internet> http://annals.org/article.aspx?articleid=2107750
Fryhofer SA Adult Immunization 2015: Another Pearl of Pneumococcal Protection. Ann Intern Med. 2015;162(3):235-236 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25643308 <Internet> http://annals.org/article.aspx?articleid=2107757 - ↑ 24.0 24.1 24.2 Bonten MJ, Huijts SM, Bolkenbaas M et al Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults. N Engl J Med 2015; 372:1114-1125. March 19, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25785969 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1408544
- ↑ 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
- ↑ Centers for Disease Control and Prevention (CDC). 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 Morb Mortal Wkly Rep. 2012 Oct 12;61(40):816-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23051612
- ↑ Centers for Disease Control and Prevention. PCV13 (pneumococcal conjugate) vaccine: Recommendations, scenarios and Q&As for healthcare professionals about PCV13 for adults. Sep 3, 2015. http://www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm
- ↑ 28.0 28.1 28.2 28.3 28.4 28.5 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 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
- ↑ 30.0 30.1 Greenhow TL, Hung YY, Herz A. Bacteremia in children 3 to 36 months old after introduction of conjugated pneumococcal vaccines. Pediatrics 2017 Apr; 139:e20162098. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28283611 <Internet> http://pediatrics.aappublications.org/content/early/2017/03/08/peds.2016-2098
- ↑ 31.0 31.1 Black CL, Williams WW, Warnock R, Pilishvili T, Kim D, Kelman JA. Pneumococcal Vaccination Among Medicare Beneficiaries Occurring After the Advisory Committee on Immunization Practices Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged >=65 Years. MMWR Morb Mortal Wkly Rep 2017;66:728-733 https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a4.htm
- ↑ 32.0 32.1 32.2 Pichichero M, Kaur R, Scott DA et al Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study. Lancet Child & Adolescent Health. June 18, 2018 Not indexed in PubMed https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30168-8/abstract
van der Linden The real impact of pneumococcal conjugate vaccines Lancet Child & Adolescent Health. June 18, 2018 Not indexed in PubMed https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30183-4/fulltext - ↑ 33.0 33.1 Hammitt LL, Etyang AO, Morpeth SC et al. Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: A longitudinal surveillance study. Lancet 2019 Apr 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31000194 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33005-8/fulltext
Klugman KP, Rodgers GL. Population versus individual protection by pneumococcal conjugate vaccination. Lancet 2019 Apr 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31000193 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30039-X/fulltext - ↑ 34.0 34.1 Branswell H U.S. advisory panel stops short of broad recommendations for two common vaccines. STAT. June 26, 2019 https://www.statnews.com/2019/06/26/u-s-advisory-panel-stops-short-of-broad-recommendations-for-two-common-vaccines/
- ↑ 35.0 35.1 Vadlamudi NK, Chen A, Marra F. Impact of the 13-valent pneumococcal conjugate vaccine among adults: A systematic review and meta-analysis. Clin Infect Dis 2019 Jul 1; 69:34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30312379 https://academic.oup.com/cid/article-abstract/69/1/34/5127380?redirectedFrom=fulltext
Weinberger DM, Shapiro ED. Prevention of pneumococcal infections in adults using conjugate vaccines: No easy answers. Clin Infect Dis 2019 Jul 1; 69:50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30312380 https://academic.oup.com/cid/article-abstract/69/1/50/5127383?redirectedFrom=fulltext - ↑ 36.0 36.1 36.2 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
- ↑ 37.0 37.1 37.2 Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. 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 Free Article https://www.cdc.gov/mmwr/volumes/68/wr/mm6846a5.htm
- ↑ 38.0 38.1 CDC: PCV13 No Longer Recommended for All Older Adults Annals of Long-Term Care. Dec 4, 2019 https://www.managedhealthcareconnect.com/content/cdc-pcv13-no-longer-recommended-all-older-adults
Freedman M, Kroger A, Hunter P, Ault KA for the Advisory Committee on Immunization Practices. Recommended Adult Immunization Schedule, United States, 2020. Ann Intern Med. 2020. Feb 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32016359 https://annals.org/aim/fullarticle/2760656/recommended-adult-immunization-schedule-united-states-2020
2024 U.S. Adult Immunization Schedule Murthy N Recommended Adult Immunization Schedule, United States, 2024 Ann Intern Med 2024. Jan 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38206843 https://www.acpjournals.org/doi/10.7326/M23-3269
Ratzan SC et al. Quality health communication is critical to optimal adult immunization. Ann Intern Med 2024 Jan 12; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38206842 https://www.acpjournals.org/doi/10.7326/M23-3452 - ↑ 39.0 39.1 39.2 AMA Morning Rounds. October 21, 2021 American Medical Association.
Walker M ACIP Streamlines Pneumococcal Vaccine Recs. Also endorses recombinant zoster vaccine for immunocompromised adults. MedPage Today October 20, 2021 https://www.medpagetoday.com/meetingcoverage/acip/95167 - ↑ 40.0 40.1 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 - ↑ Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine Among U.S. Children: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1174-1181
- ↑ 42.0 42.1 42.2 Wodi AP et al. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2024. MMWR Morb Mortal Wkly Rep 2024 Jan 11; 73:6 https://www.cdc.gov/mmwr/volumes/73/wr/mm7301a2.htm
American Academy of Pediatrics, Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedule: United States, 2024. Pediatrics 2024 Feb; 153:e2023065044 https://publications.aap.org/pediatrics/article/153/2/e2023065044/195490/Recommended-Childhood-and-Adolescent-Immunization - ↑ 43.0 43.1 Ellis R FDA Approves New Pneumococcal Vaccine. Medscape. June 18, 2023 https://www.medscape.com/viewarticle/fda-approves-new-pneumococcal-vaccine-2024a1000bcm
- ↑ 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