PCV13: How to Use the New Pneumococcal Vaccine in Adults

Hello I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic: a new pneumococcal vaccine for adults. Pneumococcal vaccine 13 (PCV13) got the nod from the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). However, it's not for everybody. Here's why it matters.

Until recently, the timing of revaccination was the most challenging part of the pneumococcal vaccine, but there's a new option to consider. We now have 2 pneumococcal vaccines that are FDA-approved for adults.

First, the one we're all familiar with: pneumococcal polysaccharide vaccine 23 (PPSV23) (Pneumovax® 23). The first pneumococcal polysaccharide vaccine, licensed in the United States in 1977, contained 14 serotypes. In 1983, an improved version containing 23 serotypes became available.

The latest product is pneumococcal conjugate vaccine (PCV13) (Prevnar 13®), which is new for adults but not new for children. The first pneumococcal conjugate vaccine, PCV7, was licensed in early 2000 for children. Ten years later, PCV13, which contained coverage for 13 serotypes, was licensed and replaced PCV7 for use in infants and young children.

On December 30, 2011, the FDA expanded use of PCV13 to adults aged 50 years or older, but it was not until June 2012 that ACIP made its recommendations on the use of PCV13 in adults. ACIP recommends it for adults aged 19 years or older, but only if they're immunocompromised. This includes patients with functional or anatomic asplenia, HIV infection, cancer, advanced kidney disease, or another immunocompromising condition. Note: Currently, PCV13 is not FDA-approved for patients aged 9-49 years.

Remember, ACIP recommendations are evidence-based, and for this vaccine that is very new for adults, the evidence base just isn't there yet. More studies are needed. Pfizer is also in the process of conducting the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA), which is designed to determine whether PVC13 prevents community-acquired pneumonia caused by one of the 13 vaccine serotypes.

It gets even more complicated. Many immunocompromised patients may have already been vaccinated with the polysaccharide vaccine. Also, what about newly immunocompromised patients? Which vaccine do you use?

Basically, there are 2 scenarios: those who have already been immunized with PPSV23, and those not immunized at all. Vaccine-naive adults (those who did not receive previous PPSV) with immunocompromising conditions should receive a single dose of PCV13, followed by a dose of PPSV-23 at least 8 weeks later. Recommendations for a second PPSV dose and PPSV dose at age 65 years or older remain unchanged.

Adults with immunocompromising conditions who already had the PPSV23 vaccine should receive a dose of PCV13 one or more years after the last PPSV23 dose was received.

For those who require additional doses of PPSV23. the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23. Total number and interval between PPSV23 doses remain unchanged.

Expect clarification and changes in recommendations as more studies are published. For Medicine Matters, I'm Dr. Sandra Fryhofer.