Technically Speaking: New Adult Pneumococcal Vaccine Recommendations
Published on in Vaccine Update for Healthcare Providers
Published on in Vaccine Update for Healthcare Providers
On Oct. 20, 2021, ACIP voted unanimously to adopt two adult pneumococcal recommendations to help reduce the burden of disease from Streptococcus pneumoniae. These recommendations have been adopted by the director of the Centers for Disease Control and Prevention (CDC) and will be published in CDC’s Morbidity and Mortality Weekly Report (MMWR).
Invasive pneumococcal disease (IPD) is “an infection confirmed by the isolation of Streptococcus pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, and pleural, joint, or peritoneal fluid but not sputum),” according to UpToDate.com. In 2019 about 30,000 IPD cases and 3,000 IPD deaths occurred. Among adults who experience IPD, about 43% are 65 years of age or older and about 48% are 19- to 64-year-olds who have been diagnosed with a chronic medical condition, immunocompromising condition, cerebral spinal fluid leak, or cochlear implant. Among all people who die from IPD, more than 50% are adults. Antibiotic resistance to penicillin and other antimicrobial agents has spread rapidly in the United States, making disease prevention through vaccination increasingly important and urgent.
In recent years, adult pneumococcal vaccination has included two vaccines, a polysaccharide vaccine that provides protection against 23 pneumococcal serotypes (PPSV23) and a conjugate vaccine that provides protection against 13 serotypes (PCV13). In their article in Vaccine, Grabenstein and Manoff note that pneumococcal immune responses from infants and young children cannot be generalized to older persons, noting, “…antibody responses of adults to PPSV23 and PCV13 are generally similar 6–12 months after vaccination, serotype for serotype, for both single and multidose regimens.” (Grabenstein JD & Manoff SB. Pneumococcal vaccines in adults: assessing the evolving evidence. Vaccine. 2011 Aug 26;29(37):6149-6154)
During 2021, the FDA approved two new conjugate pneumococcal vaccines:
Because the current PCV13 vaccine protects against serotypes that cause less than 30% of IPD in adults older than 65 years of age, the newer versions provide an important opportunity to better protect this susceptible age group. The two additional serotypes in PCV15 account for about 15% of cases in this age group, and those in PCV20, including the additional serotypes in PCV15, account for almost 30% of cases in this age group compared with those included in PCV13. Similar serotype profiles are seen in those with chronic medical conditions and those with immune-compromising conditions. To see more details, check the slides presented by Dr. Kobayashi during the October 2021 ACIP meeting.
The new adult pneumococcal recommendations offer an opportunity to use either of these newly approved vaccines, as described:
Between 2010 and 2018, pneumococcal vaccination coverage (≥ 1 dose) increased, but remained low:
To take full advantage of the opportunity to prevent pneumococcal disease, we need to utilize a variety of strategies, such as those recommended by the Community Preventive Services Task Force. Published in The Community Guide, these include:
Pharmacies should be a key component of the adult pneumococcal vaccination effort because of their access to and knowledge of patients eligible for pneumococcal vaccination. Their enormous contributions to the COVID-19 vaccination program have further positioned them as trusted providers of adult immunizations.
Licensure for children is anticipated in early 2022 for PCV15 and in early to mid-2023 for PCV20, according to Dr. Kobayashi’s presentation at the October 2021 ACIP meeting. It is hoped that pediatric use of the new pneumococcal conjugate vaccines will have a significant indirect effect on adult disease burden. However, we can realize that improvement sooner if we increase our efforts around directly immunizing adults. Won’t it be marvelous if someday our trainees have to ask what it was like to treat Streptococcus pneumococcus?
The Immunization Action Coalition’s (IAC) web section called “Ask the Experts” offers a curated list of answers to common and difficult vaccine questions. Once the updated pneumococcal recommendations are published in the MMWR, the pneumococcal vaccine section of questions and answers will be updated. “Ask the Experts” updates, as well as other IAC resources, are announced in the weekly e-newsletter, IAC Express.
Contributed by: Sharon G. Humiston, MD, MPH, FAAP
Categories: Vaccine Update November 2021, Technically Speaking
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
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