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Pneumococcal Vaccines
Katherine A. Poehling, MD, MPH
Pneumococcal Vaccines Work Group Chair
Advisory Committee on Immunization Practices
June 22, 2023
Pneumococcal Vaccines Work Group
ACIP Members
•Katherine Poehling (Chair)
•Sarah Long
Ex Officio Members
•Jeffrey Kelman (CMS)
•Lucia Lee (FDA)
•Tina Mongeau (FDA)
•Uzo Chukwuma (IHS)
•Mamodikoe Makhene (NIH)
CDC Lead
•Miwako Kobayashi (NCIRD)Liaison Representatives and Consultants
•Lynn Fisher (AAFP)
•Mark Sawyer (AAP/COID)
•Jason Goldman (ACP)
•David Nace (AGS/AMDA)
•Cora Hoover (AIM)
•Aleksandra Wierzbowski (NACI)
•James McAuley (IDSA)
•William Schaffner (NFID)
•Virginia Caine (NMA)
•Monica Farley (VAMC/Emory)
•Keith Klugman (BMGF)
•Arthur Reingold (UC Berkley)
•Lorry Rubin (CCMC)
•Richard Zimmerman (U. of Pittsburgh)
Pneumococcal Vaccines Work Group
CDC Contributors
•Adam Cohen (Respiratory Diseases Branch)
•Ryan Gierke (Respiratory Diseases Branch)
•Jennifer Farrar (Respiratory Diseases Branch)
•Diepreye Ayabina (Division of Bacterial Diseases)
•Pedro Moro (Immunization Safety Office)
•Andrew Leidner (Immunization Services Division)
•Liz Velazquez (Immunization Services Division)
•Marc Fischer (Arctic Investigations Program)
•Noele Nelson (Division of Bacterial Diseases)
GRADE/ EtR consultants
•Doug Campos -Outcalt
•Rebecca Morgan
Serotypes contained in pneumococcal vaccines
Pneumococcal conjugate vaccine s (PCVs): PCV13, PCV15, PCV20
Pneumococcal polysaccharide vaccine (PPSV): PPSV23
•PCV15 non -PCV13 : serotypes 22F and 33F
•PCV20 non -PCV15 : serotypes 8, 10A, 11A, 12F, and 15B
•PPSV23 non -PCV20 : serotypes 2, 9N, 17F, and 201 3 4 5 6A 6B 7 F 9V 14 18
C19
A19
F23
F22
F33
F8 10
A11
A12
F15
B2 9N 17
F20
PCV13
PCV15
PCV20
PPSV23
4
Extended indication for PCV20 use among children approved on
April 27, 2023
2021 2022 2023
Pediatric PCV20 use approved
April 2023
Pediatric PCV15 use approved
June 2022PCV15 and PCV20 approved
for use in adults in 2021
Both PCV15 and PCV20 were approved based on safety and
immunogenicity data compared with PCV13
•No direct PCV15 vs PCV20 comparison
•Unknown clinical implications:
•Numerically lower antibody responses vs PCV13
•Numerically higher antibody response against serotype 3 in PCV15 vs PCV13
February 2022, 2023 ACIP meeting presentations
All children under age 2 years have the same
pneumococcal vaccine recommendations
•3 primary series and a booster=“3+1” schedule
2 months
PCV4 months
PCV12–15 months
PCV6 months
PCV
Primary Series Booster
Currently, either PCV13 or PCV15 can be used
Children with certain underlying conditions are recommended
to receive PPSV23 in addition to the recommended PCV doses
Use of 15 -Valent Pneumococcal Conjugate Vaccine Among U.S. Children: Updated Recommendations of the Advisory Committee on Immuni zation
Practices — United States, 2022 | MMWR (cdc.gov)PPSV23
PPSV23 PPSV23
≥8 weeks ≥5 years
PPSV23CMC, CSF leak,
cochlear
implant Recommended
PCV doses
≥8 weeks
Immuno-
compromisedRecommended
PCV doses
CMC aged 6 –18
years
Note: Excludes catch -up vaccination schedules.
CMC=chronic medical conditions, including chronic heart disease, chronic lung disease, diabetes mellitus
CSF=cerebrospinal fluid Recommended
PCV dosesHealthy
children
Current 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
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•Children: Including asthma if treated with high -dose oral
corticosteroid therapy.
•Adults: Includes chronic obstructive pulmonary disease,
emphysema, and asthma.
→ Should we expand the indication for asthma in children?
Current 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
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 transplantShould we add “chronic liver disease” as part of pediatric
risk-based recommendation?
Current 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
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 transplantShould we expand the indication to those with stage 2 –5
chronic kidney disease?
Policy questions considered by the Work Group
•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?
Today’s Pneumococcal Vaccines session outline
Introduction Dr. Katherine Poehling
(ACIP, WG Chair)
Economic analysis and public health impact of PCV20
use in childrenDr. Charles Stoecker
(Tulane University)
Comparison of cost -effectiveness analyses on PCV20
use in childrenDr. Ayabina Diepreye
(CDC/NCIRD)
Summary of WG interpretation of EtR and policy
optionsDr. Miwako Kobayashi
(CDC/NCIRD)
VFC resolution Dr. Jeanne Santoli
(CDC/NCIRD)