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Pneumococcal Conjugate Vaccine

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Pneumococcal Conjugate Vaccine, Pneumococcal Vaccine, Pneumococcal Vaccine Indications, Polyvalent Pneumococcal Vaccine, Heptavalent Pneumococcal Conjugate Vaccine, Prevnar, Prevnar 13, PCV13, Prevnar 20, PCV20, Vaxneuvance, PCV21, Capvaxive

  • See Also
  1. Pneumovax 23
  2. Pneumococcal Pneumonia
  • Indications
  • Children
  1. All U.S. children as part of Primary Series
    1. Primary Immunization series for young children with PCV15 or PCV20
    2. Four Dose Protocol: ages 2, 4, 6 and 12-15 months
    3. Catchup for healthy children with incomplete series: 1 dose at age 24 to 59 months
  2. Age 2 years and older with immunocompromising condition
    1. Conditions
      1. Chronic illness (including Corticosteroid dependent Asthma)
      2. Functional Asplenia or anatomic Asplenia
      3. Immunocompromised state
      4. Renal disease (e.g. Nephrotic Syndrome, Renal Failure)
    2. Protocol
      1. GIve Primary Series as given to all U.S. children (see above)
      2. Also give Pneumovax 23 to high risk children >2 years old if PCV13 or PCV15 was given
        1. Pneumovax 23 is NOT required if PCV20 was administered
        2. Administer PCV13 at least 8 weeks before Pneumovax 23 (PPSV23)
        3. See Pneumovax 23 for indications in children
  • Indications
  • Adults Age >=50 years
  1. Age >=50 years criteria was lowered from age 65 years by CDC in 2024
  2. PCV21 or PCV20 alone are sufficient coverage without need for Pneumovax
    1. Prevnar 13 or Vaxneuvance should be used with Pneumovax 23
    2. CDC modified PCV21 and PCV20 recommendations for healthy seniors in 2019, 2022 and 2024
    3. NNT 2600 Prevnar 13 vaccinated healthy seniors to prevent one case of Pneumonia
      1. Prevnar 13 Vaccine in children as Primary Series has protected seniors via Herd Immunity
  3. No prior Pneumoccoal Vaccine
    1. Give 1 dose of either PCV21 or PCV20
  4. Prior Pneumovax 23 only
    1. Give 1 dose of either PCV21 or PCV20 after 1 year
  5. Prior PCV13 only
    1. Give 1 dose of either PCV21 or PCV20 after 1 year
  6. Prior PCV20 only
    1. No additional Vaccination needed
  7. Prior PCV13 AND Pneumovax 23 (PPSV23)
    1. Age 50 to 65 years: Give 1 dose of either PCV21 or PCV20 after 5 years
    2. Age 65 years and received PPSV23 after age 65 years: Consider 1 dose of either PCV21 or PCV20 after 5 years
  8. If PCV21 or PCV20 are unavailable
    1. No prior Pneumovax 23
      1. PCV15 or PCV13 after age 65 year birthday AND
      2. Pneumovax 23 at 6-12 months after PCV dose
    2. Prior Pneumovax 23 after age 65 year birthday
      1. PCV15 or PCV13 after age 65 year birthday
      2. No further Pneumovax 23 needed
    3. Prior Pneumovax 23 before age 65 year birthday
      1. PCV15 or PCV13 after age 65 year birthday AND
      2. Pneumovax 23 at 6-12 months after PCV dose AND 5 years after prior Pneumovax 23
  • Indications
  • Adults Age 18 to 50 years with Immunocompromising Condition
  1. Conditions
    1. Nephrotic Syndrome or Chronic Renal Failure
    2. Heart Disease (e.g. Congestive Heart Failure, Cardiomyopathy)
    3. Liver disease
    4. Lung Disease (e.g. Asthma, COPD)
    5. Alcoholism
    6. Diabetes Mellitus
    7. Tobacco users (over age 50 years)
    8. Immunodeficiency (congenital or acquired)
      1. Generalized Malignancy
      2. Leukemia or Lymphoma
      3. Solid Organ Transplant
      4. Immunosuppression (e.g. Chemotherapy, transplant, longterm ImmunosuppressionCorticosteroids)
      5. Human Immunodeficiency Virus
      6. Sickle Cell Disease or other Hemoglobinopathy
      7. Functional or anatomic Asplenia
        1. Administer 2 weeks prior to splenectomy
    9. Anatomic abnormalities
      1. Cerebrospinal Fluid Leak
      2. Cochlear Implant
    10. High risk environments
      1. Native American Reservations
      2. Nursing Homes
  2. Adult Vaccine age <50 years (lowered from age 65 years by CDC in 2024)
    1. Immunocompromised patients (e.g. HIV, Chemotherapy, Asplenia) or comorbidities (e.g. Tobacco, diabetes)
      1. See Pneumococcal Vaccine Indications
      2. Covered by Medicare Part B as of 2012 (CPT 90670)
      3. GIve 1 dose of PCV21 or PCV20
        1. PCV21 or PCV20 are sufficient alone, and do not require Pneumovax
        2. If prior PCV13 AND Pneumovax 23, wait 5 years, and then gIve 1 dose of PCV21 or PCV20
        3. If PCV21 or PCV20 are not available, may use PCV15 (or PCV13) AND Pneumovax 23
      4. PCV21 or PCV20 is recommended for Immunocompromised adult patients as of 2024
        1. Offers better Immunity in high risk patients
        2. PCV20 covers all but 8% of strains in age 65 years (15% for age 19 to 65) covered by Pneumovax 23
    2. Timing with Pneumovax 23 (not required if PCV21 or PCV20 used)
      1. No prior Pneumovax
        1. Give Prevnar 13 or Vaxneuvance at least 8 weeks before Pneumovax 23
      2. Prior Pneumovax
        1. Give Prevnar 13 or Vaxneuvance at least one year after Pneumovax 23
  • Medications
  1. PCV21 (Capvaxive)
    1. Released in U.S. in 2024 coinciding with routine PCV21 dosing in age 50 years and older (per CDC)
    2. PCV21 covers 10 of same serotypes as PCV20 and 11 additional (77-85% of invasive pcp causes)
    3. Preferred Vaccine in adults as of 2024 (not approved for use under age 18 years as of 2024)
    4. PCV21 may be given alone (without Pneumovax) for all pneumococcal Vaccination
  2. PCV20 (Prevnar 20)
    1. Expands on Prevnar 13 to contain 7 additional serotypes for a total of 20
    2. Preferred Vaccine in children as of 2024, and may be used alone without Pneumovax
    3. Available for use in adults and Children (contrast with PCV21 only approved for adults as of 2024)
    4. Covers all but 8% of strains in age 65 years (15% for age 19 to 65) that are covered by Pneumovax 23
      1. Covers 54 to 65% of invasive pneumococcal disease serotypes (contrast with 77-85% for PCV21)
      2. Covers serotype 4 (in contrast to PCV21) and may be preferred in higher risk regions/conditions
        1. Serotype 4 is more common with Alcoholism, Homelessness
        2. Serotype 4 is also more common in Alaska, Colorado, New Mexico and Oregon
  3. PCV15 (Vaxneuvance)
    1. Contains 15 serotypes (misses 15% of invasive pneumococcal disease covered by Prevnar 20)
    2. Available for use in adults and expected approval for children in 2022
    3. If used in place of Prevnar 20, then also give Pneumovax 23 (at appropriate interval)
  4. PCV13 (Prevnar 13)
    1. Contains 13 serotypes
      1. Replaces the Prevnar-7 and includes the prior serotypes and 6 new ones
    2. Prior seven valent Vaccine covered serotypes most affecting children
      1. Serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F
      2. These serotypes are responsible for >80% of Meningitis and bacteremia in age <6 years
  5. Components
    1. Pneumococcal Polysaccharide conjugated to non-toxic Diphtheria toxin
    2. Conjugated Vaccines generate longer lasting, better Immunity than PolysaccharideVaccines
      1. Increased memory cell production
  6. Differs from the adult Vaccine (Pnu-Imune 23)
    1. Prevnar is more immunogenic
    2. Prevnar does not contain Thimerosal
  1. Infections caused by Streptococcus Pneumoniae (age <6)
    1. Community Acquired Pneumonia (leading cause)
    2. Otitis Media (leading cause)
    3. Bacterial Meningitis (leading cause)
    4. Streptococcus bacteremia
  2. Antibiotic Resistance is growing
    1. Penicillin Resistant Pneumococcus now 24% of isolates
  • Efficacy
  • Highly effective
  1. Prevents 94-97% invasive disease by immunized serotypes
  2. Decreases Acute Otitis Media episodes in infants
  3. Significant reduction in pneumococcal Meningitis since Vaccine introduction (esp. <2 years old)
    1. Hsu (2009) N Engl J Med 360(3): 244-56 [PubMed]
  • Adverse Effects
  1. No serious adverse effects
  2. Fever to 38 F
  3. Febrile Seizure (esp. when combined with Influenza Vaccine)
  4. Local inflammation at injection site
  • Dosing
  • Primary Series Schedule started in infancy (PCV13, PCV15 or PCV20)
  1. Four doses: 2, 4, 6 and 12 to 15 months
  • Dosing
  • Primary Series Catch up dosing based on age at first dose (PCV13, PCV15 or PCV20)
  1. Age 2 to 6 months
    1. Primary Series: 3 doses, two months apart
    2. Booster: 12 to 15 months
  2. Age 7 to 11 months
    1. Primary Series: 2 doses, two months apart
    2. Booster: 12 to 15 months
  3. Age 12 to 23 months
    1. Primary Series: 2 doses, two months apart
  4. Age 24 to 59 months in healthy child
    1. Primary Series incomplete: one dose
  5. Age 24 to 59 months in child with chronic illness
    1. Indicated conditions
      1. Sickle Cell Anemia
      2. Asplenic patient
      3. HIV Infection
      4. Other chronic illness
      5. Immunocompromising condition
    2. Primary Series incomplete: two doses, two months apart
  6. Age 5 years and older
    1. Catch-Up Vaccination not recommended
  • Dosing
  • Comorbid Conditions
  1. Schedules vary by underlying conditions (see CDC guidelines)
    1. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html
  • References
  1. (2012) Presc Lett 19(12): 69
  2. (2014) Presc Lett 21(11): 63-64
  3. (2019) Presc Lett 26(9): 49
  4. (2021) Presc Lett 28(12): 67-8
  5. (2022) Presc Lett 29(3): 13
  6. (2024) Presc Lett 31(12): 67-8
  7. Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]
  8. Black (2000) Pediatr Infect Dis J 19:187-95 [PubMed]
  9. Eskola (2001) N Engl J Med 344:403-9 [PubMed]
  10. Kobayashi (2022) MMWR Morb Mortal Wkly Rep 71(4): 109-17 [PubMed]
  11. Rennels (1998) Pediatrics 101(4 pt 1):604-11 [PubMed]
  12. Shinefield (1999) Pediatr Infect Dis J 18:757-63 [PubMed]
  13. Zimmerman (2001) Am Fam Physician 63(10):1991-2004 [PubMed]
  14. (2000) MMWR Morb Mortal Wkly Rep 49(RR-9):1-35 [PubMed]