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