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Practice Guideline
. 2024 Sep 12;73(36):793-798.
doi: 10.15585/mmwr.mm7336a3.

Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024

Miwako Kobayashi, Andrew J Leidner, Ryan Gierke, Jennifer L Farrar, Rebecca L Morgan, Doug Campos-Outcalt, Robert Schechter, Katherine A Poehling, Sarah S Long, Jamie Loehr, Adam L Cohen
Practice Guideline

Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024

Miwako Kobayashi et al. MMWR Morb Mortal Wkly Rep. .

Abstract

On June 17, 2024, the Food and Drug Administration approved 21-valent pneumococcal conjugate vaccine (PCV) (PCV21; CAPVAXIVE; Merck Sharp & Dohme, LLC) for adults aged ≥18 years. PCV21 does not contain certain serotypes that are included in other licensed pneumococcal vaccines but adds eight new serotypes. The Advisory Committee on Immunization Practices (ACIP) recommends use of a PCV for all adults aged ≥65 years, as well as adults aged 19-64 years with certain risk conditions for pneumococcal disease if they have not received a PCV or whose vaccination history is unknown. Previously, options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals, Inc.) alone or a 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme, LLC) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23; Merck Sharp & Dohme, LLC). Additional recommendations for use of PCV20 exist for adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13; Prevnar13; Wyeth Pharmaceuticals, Inc.). The ACIP Pneumococcal Vaccines Work Group employed the Evidence to Recommendations framework to guide its deliberations on PCV21 vaccination among U.S. adults. On June 27, 2024, ACIP recommended a single dose of PCV21 as an option for adults aged ≥19 years for whom PCV is currently recommended. Indications for PCV have not changed from previous recommendations. This report summarizes evidence considered for these recommendations and provides clinical guidance for use of PCV21.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Katherine A. Poehling reports grant support from the North Carolina Baptist Foundation for support of Safe Sleep supplies for all newborns and Early Child Education Fellow with Love Out Loud, a local nonprofit; Optum Social Responsibility, for support of Intimate Partner Violence Collaborative Pilot; Atrium Health Wake Forest Baptist Clinical and Translational Science Institute for Because You Matter: Conversations You Want About COVID-19 and Text Messaging Follow-up for Patients who missed Well-child visits; and the Kate B. Reynolds Foundation for Re-imagining Health and Well-being by Mothers for our Babies, Families, and Community; volunteer service as a board member of the Children’s Law Center of Central North Carolina, a local nonprofit (https://www.childlawnc.org); and a volunteer role as senior editor of Academic Pediatrics. No other potential conflicts of interest were disclosed.

Figures

FIGURE
FIGURE
Serotypes*,† included in pneumococcal vaccines currently recommended for adults — United States, 2024 Abbreviations: PCV = pneumococcal conjugate vaccine; PCV15 = 15-valent PCV; PCV20 = 20-valent PCV; PCV21 = 21-valent PCV; PPSV23 = 23-valent pneumococcal polysaccharide vaccine. * PCV21 is approved for the prevention of invasive pneumococcal disease caused by serotype 15B based upon prespecified criteria for the proportion of participants with fourfold or more rise in OPA responses. https://www.fda.gov/media/179426/download?attachment. † PCV21 contains serotype 20A.
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References

    1. CDC. Active Bacterial Core surveillance (ABCs): surveillance reports. Atlanta, GA: U.S Department of Health and Human Services; 2024. https://www.cdc.gov/abcs/reports/index.html
    1. Kobayashi M, Pilishvili T, Farrar JL, et al. Pneumococcal vaccine for adults aged ≥19 years: recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023;72 (No. RR-3):1–39. 10.15585/mmwr.rr7203a1 - DOI - PMC - PubMed
    1. Center for Biologics Evaluation and Research. CAPVAXIVE. Silver Spring, MD: Food and Drug Administration; 2024. https://www.fda.gov/vaccines-blood-biologics/capvaxive
    1. Kobayashi M. Evidence to recommendations framework: PCV20 use among adults who previously received PCV13 [Presentation slides]. Presented at the Advisory Committee on Immunization Practices meeting, Atlanta, GA; October 19, 2022. https://stacks.cdc.gov/view/cdc/122357
    1. Orell L, Massay S, Steinberg J, et al. ISPPD-13: increase in invasive pneumococcal disease due to Streptococcus pneumoniae serotype 4—Alaska, 2013–2022. Geneva, Switzerland: International Society of Pneumonia and Pneumococcal Diseases; 2024. https://info.kenes.com/Flip/ISPPD24_ISPPD24/

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