By Tim Drake, PharmD, MBA, BCPS

Assistant Professor of Pharmacy, College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT

Dr. Drake reports no financial relationships relevant to this field of study.

SYNOPSIS: CDC/ACIP no longer recommend the 13-valent pneumococcal conjugate vaccine for most healthy adults.

SOURCES: Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices Recommendations, June 2019. Available at: http://bit.ly/34YLH55. Accessed Dec. 6, 2019.

Centers for Disease Control and Prevention. Vaccines and preventable diseases. Pneumococcal vaccination. Available at: http://bit.ly/2DU4Kle. Accessed Dec. 6, 2019.

Previously, the CDC recommended people ≥ 65 years of age receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal vaccine one year apart.1 This was based on a 2014 recommendation from the Advisory Committee on Immunization Practices (ACIP).2 Before 2014, the 13-valent vaccine was used primarily in the pediatric population. The 13-valent vaccine contains one serotype that is not present in the 23-valent vaccine.3 Additionally, although unproven, conjugate vaccines are thought to enhance immunogenicity.4 The recommendation was to administer the 13-valent vaccine first at age 65 years, then administer the 23-valent vaccine one year later if it has not been given in the past five years.1 This recommendation was somewhat controversial because of the large overlap in serotypes between the two vaccines. It is estimated that 2,600 healthy seniors would need to be vaccinated to prevent one outpatient pneumonia case.5 For invasive pneumonia, this number grows to about 26,000.5 The price of one dose of the 13-valent vaccine is about $183 vs. about $97 per dose for the 23-valent vaccine.6 Also, herd immunity from pediatric vaccination has been effective in reducing exposure to pneumococcal bacteria.5 With the 2014 recommendation, ACIP agreed to revisit the recommendation in four or five years to study safety and cost-effectiveness.2 In 2019, ACIP re-examined the data and concluded the 23-valent vaccine still should be recommended. The 13-valent vaccine should be considered based on shared clinical decision-making but is no longer a universal recommendation for all people ≥ age 65 years. All other former indications for both vaccines, such as for those with immunocompromising conditions or asplenia, will remain the same. This updated recommendation was forwarded to the CDC, which recently adopted the guideline for the pneumococcal vaccines.

COMMENTARY

This is a great example of what to do when there are not enough data to clearly support a recommendation. First, make a recommendation based on current best data. Second, develop a plan with a defined timeline to justify the recommendation. Third, gather and study the data. Fourth, revisit the original recommendation and determine if it is still justified based on current data.

REFERENCES

  1. Centers for Disease Control and Prevention. Pneumococcal vaccine timing for adults. Available at: http://bit.ly/2DRnQZ5. Accessed Dec. 6, 2019.
  2. Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014;63:822-825.
  3. Wyeth Pharmaceuticals, Inc. Product information for Prevnar 13, August 2017. Available at: http://bit.ly/38d4prS. Accessed Dec. 6, 2019.
  4. Centers for Disease Control and Prevention. Pneumococcal disease. In: Epidemiology and Prevention of Vaccine-Preventable Disease — The Pink Book: 13th Ed; 2015. Available at: http://bit.ly/2qrlA7Q. Accessed Dec. 6, 2019.
  5. Foster S, Goad J. Your guide to the latest in immunization practice. APhA Annual Meeting and Exposition, Seattle, March 22-25, 2019. Available at: http://bit.ly/2sNfGP7. Accessed Dec. 6, 2019.
  6. GoodRx. Pneumovax 23. Available at: http://bit.ly/2PiiZ8Q. Accessed Dec. 6, 2019.