Immunization Update
Maria G. Tanzi, PharmD
CDC recently approved new pneumococcal vaccine (PCV) recommendations. Now, CDC recommends the use of either 20-valent pneumococcal conjugate vaccine (PCV20) alone or 15-valent pneumococcal conjugate vaccine (PCV15) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65 years or older and for adults aged 19 to 64 years with certain underlying medical conditions or other risk factors who have not previously received a PCV vaccine or whose previous vaccination history is unknown.
The updated recommendations are simpler than the 2019 ones, which included shared clinical decision-making for PCV13 in select older adults. However, the use of PCV13 is no longer recommended for adults, and the recommendation to use PCV15 or PCV20 offers patients a vaccine option with protection against additional pneumococcal serotypes.
“It’s good news that more pneumococcal serotypes are now targeted with PCVs,” said John D. Grabenstein, PhD, RPh, director of scientific communication for Immunize.org. “Of greatest importance is reaching the millions of adults who have never received the protection of pneumococcal vaccines or are not up to date on their adult vaccines.”
This is also the first time CDC and the Advisory Committee on Immunization Practices (the group that develops the guidance) have routinely recommended any pneumococcal conjugate vaccine for certain risk populations, such as those with diabetes or asthma, for ages 19 to 64 years.
Dosing intervals, coadministration
If PCV20 is used, no additional doses are needed, said CDC. If PCV15 is given, the recommended dosing interval between PCV15 and PPSV23 is at least one year. In select situations, such as for adults who are immunocompromised or have a cochlear implant, a minimum interval of 8 weeks between vaccines can be considered. Adults who have previously received PPSV23 may receive either PCV20 or PCV15 at least one year after their last dose of PPSV23.
If PCV15 is used in those with a history of receiving PPSV23, it does not need to be followed by another dose of PPSV23. CDC noted that the benefits of providing PCV15 or PCV20 in those who received PCV13 only or both PCV13 and PPSV23 has not been evaluated, and these adult patients should complete the previously recommended PPSV23 series.
CDC said all of the pneumococcal vaccines (i.e., PCV15, PCV20, or PPSV23) can be coadministered with quadrivalent inactivated influenza vaccines. There are no data available on coadministration with other vaccines (e.g., zoster, hepatitis B, etc.), however, and coadministration with COVID-19 vaccines is currently being evaluated.
Clinical considerations
Pharmacists should be familiar with these updated recommendations and ensure clear documentation is used when updating a patient’s vaccine record.
Clinicians should not document the receipt of these vaccines as simply “pneumococcal vaccine,” but instead clearly indicate if PPSV23, PCV15, or PCV20 was given. Additionally, clinicians should educate patients on when to return for subsequent pneumococcal vaccines (if needed) and about potential adverse effects. Some of the most frequently reported adverse events with the PCV15 and PCV20 vaccines were injection site pain, fatigue, and myalgia.
“This is only an intermediate step as pneumococcal vaccines with additional serotypes are approved,” said Stephan Foster, PharmD, FAPhA, CAPT (Ret), USPHS. “Also, we will need to continue to watch the effects these vaccines will have on herd immunity for adults once we start vaccinating children with them.”
PneumoRecs VaxAdvisor
CDC has created a mobile app called the PneumoRecs VaxAdvisor that is aimed at helping providers quickly and easily determine which pneumococcal vaccines are needed. The app contains information for children and adults and was updated in early February 2022 to incorporate the latest up-to-date pneumococcal recommendations from CDC.
In the app, the user enters a patient’s age, notes if the patient has specific underlying medical conditions, and answers a few questions about the patient’s pneumococcal vaccination history. The app then provides patient-specific guidance consistent with the immunization recommendations. Additional information about this app can be found on CDC’s website: www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html. ■