Key takeaways:
The PCV20 and PCV15 vaccines were approved in 2021. Prior to that, there were only two pneumonia vaccines available: PPSV23 and PCV13.
Eligible patients and vaccine intervals changed frequently between 2010, when PCV13 was approved, and 2021, when the two new pneumonia vaccines were introduced.
The Advisory Committee on Immunization Practices’ 2022 recommendations are to give PCV15 followed by PPSV23 at least one year later in most patients, or to give one dose of PCV20.
You might remember the approval of the pneumococcal 13-valent conjugate vaccine (PCV13), Prevnar 13, in 2010. It is indicated in children as well as in adults 18 years of age or older. The pneumococcal polyvalent vaccine (PPSV23), Pneumovax 23, has been available since 1983.
The FDA approved two pneumococcal vaccines in 2021: the pneumococcal 20-valent conjugate vaccine (PCV20), branded Prevnar 20, and the pneumococcal 15-valent conjugate vaccine (PCV15), or Vaxneuvance. With their approval came changes to the Advisory Committee on Immunization Practices’ (ACIP) recommendations for adult pneumonia vaccination.
All of these changes can get confusing. So here, we’ll look at previous adult pneumonia recommendations and what’s changed since the approval of PCV20.
What were the old recommendations?
Prior to the approval of PCV20, the two pneumonia vaccines incorporated into ACIP recommendations were PPSV23 and PCV13. ACIP’s recommendations were divided between those who were 65 and older and those aged 19 to 64.
2014
The ACIP initially recommended PCV13 for all adults 65 and older followed by PPSV23 between 6 to 12 months later, with a minimum interval of 8 weeks. However, multiple studies later showed that a longer interval between shots could reduce the chance of local reactions and also improve the immune response. So the ACIP recommended spacing the vaccines at least 1 year apart. In both cases, they recommended against administering them together.
2019
In 2019, ACIP changed the recommendations again, based on updated population-level evidence. This time, they recommended all adults 65 and older get one dose of PPSV23. But they urged shared decision-making when giving PCV13 to adults 65 and older who didn’t have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant.
From 2000 to 2014, before the adult PCV vaccination recommendations, the number of invasive pneumonia cases due to a subtype found in the PCV13 declined dramatically. This was before PCV13 was recommended in adults and was due to indirect protection from children getting vaccinated.
ACIP expected further reductions in pneumonia cases from a PCV13 subtype after adults started getting the vaccine. But from 2014 to 2017, there were no additional reductions. Because of this, it was unclear that giving adults the PCV13 offered any protection beyond what they were already receiving from the children around them being vaccinated. Hence the change in recommendations.
2021
In 2021, the FDA approved the PCV20 vaccine based on serologic data that suggested it would be effective against the seven additional serotypes the PCV13 vaccine didn’t cover. While the PPSV23 vaccine covers those serotypes, that vaccine hasn’t shown effectiveness against non-bacteremic pneumococcal pneumonia, which the FDA notes is more common than invasive disease.
Also, based on that data, the FDA anticipates PCV20 to be effective in preventing both invasive and non-invasive pneumococcal pneumonia. As a condition of approval, though, the FDA is requiring the manufacturer to do follow-up studies to confirm the real-world effectiveness of the vaccine.
When PCV13 was approved, the FDA also required a follow-up study, which confirmed that PCV13 was effective at preventing both invasive disease and pneumonia. Since PCV13 and PCV20 are nearly identical (except for the additional serotypes) there is no reason to expect PCV20 won’t be effective in the real-world setting.
How did PCV20 approval change ACIP recommendations?
The recommendation changes made in response to PCV20’s approval have simplified pneumonia vaccination for adults. They’ve also made it easier to get adults vaccinated by reducing the number of shots required.
As of 2022, the recommendations are to give either the PCV20 vaccine or the PCV15 vaccine. However, if you administer the PCV15 vaccine, you should give PPSV23 at least 1 year later in most people. You can consider a minimum interval of 8 weeks in those with immunocompromising conditions, a cochlear implant, or a cerebrospinal fluid leak. That’s to minimize the time these patients go without being fully vaccinated against pneumococcal pneumonia.
The bottom line
Why trust our experts?
The introduction of the PCV20 vaccine provides an additional option for protecting patients against invasive pneumonia. While there have been numerous changes to pneumonia vaccine recommendations in the past 10 years, the newest recommendations provide a simple way forward in pneumococcal vaccination.
