Should a 71-year-old female who received Prevnar13 (Pneumococcal conjugate vaccine) 6 years ago and Pneumovax23 (Pneumococcal polysaccharide vaccine) 13 years ago get Prevnar20 (Pneumococcal conjugate vaccine) now?

From the Guidelines

Yes, a 71-year-old female who received Prevnar13 six years ago and Pneumovax23 thirteen years ago should get Prevnar20 now. According to the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) in 2023 1, adults who have previously received pneumococcal vaccines, such as PCV13 and PPSV23, can receive a dose of PCV20 after a certain interval. Since this patient received PCV13 six years ago and PPSV23 thirteen years ago, she falls into the category of having received PCV13 and one dose of PPSV23. The recommendation for this category is to administer a single dose of PCV20 after a ≥5 year interval since the last PCV13 or PPSV23 dose. Given that it has been more than five years since her last PCV13 dose, she is eligible for the PCV20 vaccine.

Key Points to Consider:

• The patient's age and previous vaccination history make her eligible for the updated PCV20 vaccine.
• PCV20 provides protection against additional strains of pneumococcal bacteria not covered by PCV13, enhancing her protection against pneumococcal disease.
• The administration of PCV20 is a single intramuscular injection, and no additional pneumococcal vaccines would be needed after receiving it.
• This recommendation aims to offer broader protection against serious infections like pneumonia, meningitis, and bloodstream infections, which are more common and severe in older adults.
• The guidelines from 1 emphasize the importance of updating vaccination coverage, especially considering the time elapsed since her previous vaccinations.

From the FDA Drug Label

7.1 Prior Vaccination With PNEUMOVAX 23 In adults, receipt of PPSV23 1 to 5 years prior to Prevnar 20 resulted in diminished OPA geometric mean titers (GMTs) to Prevnar 20 compared to OPA GMTs in recipients who received Prevnar 13 at least 6 months prior to Prevnar 20, and compared to OPA GMTs in recipients who received Prevnar 13 followed by PPSV23, with the last dose of PPSV23 given at least 1 year prior to Prevnar 20 [see Clinical Studies (14.2)].

The patient received PPSV23 13 years ago and Prevnar13 6 years ago. Since the last dose of PPSV23 was given more than 5 years prior to the potential Prevnar20 vaccination, the diminished OPA GMTs may not be a significant concern. However, the FDA label does not provide a direct recommendation for this specific scenario. Key points:

• The patient's prior vaccinations do not directly contraindicate the use of Prevnar20.
• The label does not provide explicit guidance on the optimal timing for Prevnar20 administration in this scenario. Given the available information, it is unclear whether the patient should receive Prevnar20 now. A conservative clinical decision would be to consult the latest clinical guidelines and consider the patient's individual risk factors and medical history before making a decision 2.

From the Research

Pneumococcal Vaccination Recommendations

The user is inquiring about whether a 71-year-old female who received Prevnar13 (Pneumococcal conjugate vaccine) 6 years ago and Pneumovax23 (Pneumococcal polysaccharide vaccine) 13 years ago should get Prevnar20 (Pneumococcal conjugate vaccine) now.

Relevant Studies

• A study published in 2021 3 found that PCV20 was well tolerated and immunogenic in adults ≥65 years of age previously vaccinated with different pneumococcal vaccine regimens.
• Another study published in 2021 4 evaluated the safety, tolerability, and immunogenicity of PCV20 in adults 60 to 64 years of age and found that PCV20 was well tolerated with a safety profile consistent with historical experience of PCVs in this age group.
• A study published in 2013 5 found that initial vaccination with PCV13 establishes an immune state that results in recall anti-pneumococcal responses upon subsequent vaccination with either conjugated or free polysaccharide vaccine.

Key Points to Consider

• The Advisory Committee on Immunization Practices (ACIP) recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years 6.
• PCV20 contains the components of PCV13 and includes capsular polysaccharide conjugates for 7 additional serotypes, which may provide benefits of immunization with a conjugate vaccine to individuals previously immunized with a pneumococcal polysaccharide vaccine 3.
• The user's vaccination history and age suggest that she may benefit from receiving PCV20 to expand her protection against pneumococcal disease.

Potential Benefits of PCV20

• Expanded protection against pneumococcal disease
• Robust immune responses to the 20 vaccine serotypes
• Well tolerated with a safety profile consistent with historical experience of PCVs in this age group

Decision

Based on the available evidence, it appears that the user may benefit from receiving PCV20 to expand her protection against pneumococcal disease. However, the final decision should be made in consultation with a healthcare professional, taking into account the user's individual health status and medical history.