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pneumococcal congugate vaccine (Prevnar, Prevnar 13, PCV13, Prevnar-20, PCV20, Prevnar-15, PCV15, Vaxneuvance, Capavaxive, PCV21, PHiD-CV10, PCV10, Synflorix)

Tradenames: - PCV10 = Synflorix - PCV15 = Vaxneuvance - PCV20 = Prevnar (Pfizer) - PCV21 = Capvaxive (Merk) [43] * PCV13 no longer available [42] Indications: 1) vaccination at 2, 4, 6 & 12-15 months for all children 23 months & younger - 2 doses may be equally effective [8] 2) all children 23 months & younger who have not received doses of the vaccine should be given catch up doses 3) the vaccine may be administered concurrently with other childhood immunizations 4) children 24-59 months of age with high-risk conditions a) sickle cell disease b) splenic abnormalities c) HIV infection d) primary immunodeficiency e) immunosuppressive therapy 5) all immunodeficient children 6-18 years of age regardless of prior vaccination with pneumococcal polysaccharide vaccine [15] 6) approved for use in adults aged >=50 and older to prevent pneumonia & invasive disease caused by S pneumoniae [12]; 7) CDC's Advisory Committee on Immunization Practices (ACIP) recommends - for all adults >= 65 years [13,21,23] - 20-valent (PCV20) pneumococcal conjugate vaccine by itself [40] or - 15-valent ( PCV15)vaccine followed by PPSV23 if not already received PPSV23 [39] - currently PPSV23 + PCV13 as a shared decision process [34] - Prevnar-13 prior to this recommended for at risk seniors - immunosuppression, CSF leak, or cochlear implant [37] - long-term care residemts [37] 8) protects against otitis media in children [32] 9) infant pneumococcal conjugate vaccine in Kenya was followed by a decrease in vaccine-type invasive pneumococcal disease in all age groups [33] 10) 13-valent pneumococcal conjugate vaccine during childhood reduced incidence of invasive pneumococcal disease in adults [35] 11) PCV13 is expensive & unnecessary for healthy elderly [36,38] 12) 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] - minimum interval between PCV13 & PPSV23 is 8 weeks [28] - consider minimum interval in patients with asplenia [28] - 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: 1) effective for prevention of pneumococcal meningitis 2) reduces incidence of otitis media [3] a) at least 3 vaccinations required for sustained benefit b) 7% reduction in office visits for otitis media in 1st year of life c) 24% reduction in tympanostomy d) 35% fewer antibiotic prescriptions 3) 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] 4) reduces risk of non-bacteremic community-acquired pneumonia due to Streptococcus pneumoniae resistant to Pneumovax by 45% - mechanism of how IgG & IgM could facilitate this is not discussed [24] 5) reduces incidence of viral pneumonia [6] 6) reduces nasopharygeal carrier rate in children [10] 7) 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]

Related

pneumococcal polysaccharide vaccine, polyvalent (PneumoVax 23, Pnu-Immune 23, PPSV-23) Streptococcus pneumoniae (pneumococcus)

Specific

pneumococcal capsular antigen diphtheria CRM197 protein conjugate vaccine

General

pneumococcal vaccine

References

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