Give More Adults a Pneumococcal Vaccine

We’re getting lots of questions about pneumococcal vaccines for adults...due to updates in CDC recommendations plus the new PCV21 vaccine.

When should adults get vaccinated? Recommend routine pneumococcal immunization for adults now at age 50 years and older...instead of age 65.

Explain that CDC is lowering the age for vaccination partly because many adults 50 to 64 already have risks for invasive pneumococcal disease. And serious infections peak in some populations (Blacks, etc) at 55 to 59.

Continue to vaccinate adults 19 to 49 years with immunocompromising conditions (cancer, HIV, etc) or risk factors (diabetes, smoking, etc).

How does PCV21 stack up? PCV21 (Capvaxive) is a pneumococcal conjugate vaccine like PCV15 (Vaxneuvance) or PCV20 (Prevnar 20).

But point out that PCV21 isn’t just “PCV20 plus 1.”

PCV21 covers 10 of the same serotypes as PCV20...plus 11 others.

And PCV21 protects against 8 serotypes not in any other vaccine.

CDC estimates that PCV21 targets serotypes that cause 77% to 85% of invasive pneumococcal disease...versus 54% to 65% with PCV20.

But unlike PCV20 or PCV15, PCV21 doesn’t cover serotype 4...which is causing over 30% of invasive disease in certain adults in the western US.

Which pneumococcal vaccine should adults get? Rely on PCV20 or PCV21 as your workhorse product. One dose of either vaccine will get all patients 19 and older needing pneumococcal vaccination up-to-date.

For PCV-naive patients, PCV15 is another option. But it requires getting PPSV23 (Pneumovax 23) usually a year later, based on risks.

See CDC’s PneumoRecs VaxAdvisor app or website for full guidance.

Then consider our practical approach in the table below...and in our Pneumococcal Vaccination in Adults algorithm...to simplify.

In general, focus on getting eligible adults vaccinated with PCV20 or PCV21...rather than worrying too much about which product they get.

But weigh nuances...and consider your population, location, etc.

For example, go with PCV21 for better overall serotype coverage.

But lean toward PCV20 if invasive pneumococcal disease due to serotype 4 is a concern...such as for adults in Alaska, Colorado, New Mexico, and Oregon who have alcoholism or are experiencing homelessness.

Keep in mind that PCV21 is currently only approved for ages 18 years and up. But PCV20 can be used to immunize BOTH adults and children.

Point out that PCV21 costs about $290/dose...PCV20 about $265/dose. Medicare Part B will cover any recommended option. But it may take other payers time to align coverage benefits to updated CDC recommendations.

Dig into our updated chart, Comparison of Pneumococcal Vaccines.

• Algorithm: Pneumococcal Vaccination in Adults