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Pneumococcal Vaccines Work Group Considerations and
Next Steps
Miwako Kobayashi, MD, MPH
Pneumococcal Vaccines Work Group
Advisory Committee on Immunization Practices
February 22, 2023
Proposed Policy Questions
Should PCV20 be recommended as an option for pneumococcal
conjugate vaccination according to currently recommended dosing and schedules, for U.S. children aged <2 years?
Should PCV20 without PPSV23 be recommended as an option for pneumococcal vaccination for U.S. children aged 2–18 years with underlying medical conditions that increase the risk of pneumococcal disease?
Additional Considerations
Cost-effectiveness analysis will be performed to assess:
• Incremental benefit of PPSV23 use in addition to PCV20 in children
aged 2–18 years with underlying medical conditions.
• Incremental benefit of PCV20 use in children who completed the
recommended PCV series with either PCV13 or PCV15.
Pneumococcal Disease Risk in Children with Underlying Medical
Conditions
Asthma, Chronic Kidney Disease, Chronic Liver Disease
Are childre n wit h chroni c kidne y disease o f an y stag e a t increase d risk
o f pneumococca l disease? Specific Questions Being Considered by the Work
Group
•
•
• Are children with chroni c live r diseas e a t increase d risk o f pneumococcal
disease? Are children with asthma at increased risk of pneumococcal disease
regardless o f high-dose oral corticosteroid use?
Differences in the Indications for Children vs Adults
with Asthma
• Pediatric recommendation1,2:
• Including asthma if treated with high-dose oral
corticosteroid therapy
• Adult recommendation3,4:
• Includes chronic obstructive pulmonary disease,
emphysema, and asthma
1. Nuorti et al. MMWR RR 2010
2. Kobayashi et al. MMWR 2022. 71(37); 1174–1181
3. Matanock et al. MMWR 2019
4. Kobayashi et al. MMWR 2022. 71(4); 109–117
Risk-Based Pneumococcal Vaccine Recommendations
Diabetes mellitus
Cerebrospinal fluid leak Cochlear implant Chronic renal failure or nephrotic syndrome Congenital or acquired asplenia, or splenic
dysfunction
Congenital or acquired immunodeficiency
Diseases and conditions treated with
immunosuppressive drugs or radiation therapy
HIV infection
Sickle cell disease or other hemoglobinopathies
Solid organ transplant
Should we add “chronic liver disease” as part of pediatric
risk-based recommendation? Children Adults
Alcoholism
C
hronic heart disease
Ch
ronic lung disease
Chronic liver disease
Cigarette smoking
Risk-Based Pneumococcal Vaccine Recommendations
Children Adults
Alcoholism
Chronic heart disease
Chronic lung disease Chronic liver disease Cigarette smoking
Diabetes mellitus
Cerebrospinal fluid leak Cochlear implant
or nephrotic syndrome
Chronic renal failure
Congenital or acquired asplenia, or splenic
dysfunction
Congenital or acquired immunodeficiency
Diseases and conditions treated with
immunosuppressive drugs or radiation therapy
HIV infection
Sickle cell disease or other hemoglobinopathies
Solid organ transplant The intent has been to provide additional protection for
those on dialysis or about to be on dialysis
Should the risk-based recommendations be expanded to
all CKD stages?
Work Group Next Steps
Work Group Next Steps
• Review of evidence and Work Group interpretation of remaining EtR domains
(Values, Acceptability, Resource Use, Feasibility )
• Review findings from cost-effectiveness analyses (CDC and other groups)
• Draft policy options on PCV20 use in U.S. children for consideration by the committee
Questions for the Committee
• Does the Committee agree with the policy questions being
considered by the Work Group?
• Are there additional data the Committee would like to see before deciding on policy options for a vote?
For more information, contact CDC
1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.