What pneumococcal vaccines (Streptococcus pneumoniae vaccines) are available at USA outpatient clinics?

Available Pneumococcal Vaccines in USA Outpatient Clinics

Four pneumococcal vaccines are currently licensed and available for use in USA outpatient clinics: PPSV23 (Pneumovax23), PCV13 (Prevnar13), PCV15 (Vaxneuvance), PCV20 (Prevnar20), and most recently PCV21. 1

Available Pneumococcal Vaccines

Conjugate Vaccines (PCVs)

1. PCV13 (Prevnar13)

   • Manufacturer: Pfizer
   • Contains 13 pneumococcal serotypes
   • FDA approved for adults ≥18 years
   • Licensed for adults since 2011 1

2. PCV15 (Vaxneuvance)

   • Manufacturer: Merck
   • Contains 15 pneumococcal serotypes (includes all PCV13 serotypes plus 22F and 33F)
   • FDA approved for persons aged ≥6 weeks
   • Licensed for adults since 2021 1

3. PCV20 (Prevnar20)

   • Manufacturer: Pfizer
   • Contains 20 pneumococcal serotypes
   • FDA approved for adults ≥18 years
   • Licensed for adults since 2021 1, 2

4. PCV21

   • Recently approved (2024)
   • Contains 8 pneumococcal serotypes not included in previously recommended vaccines
   • Note: Does not contain serotype 4, which is important in certain geographic regions 1

Polysaccharide Vaccine

1. PPSV23 (Pneumovax23)
   • Manufacturer: Merck
   • Contains 23 pneumococcal serotypes
   • FDA approved for adults ≥50 years and persons ≥2 years at increased risk
   • Licensed for adults since 1983 1

Current Vaccination Recommendations

The Advisory Committee on Immunization Practices (ACIP) recommends:

1. For adults ≥65 years and adults 19-64 years with certain underlying conditions:

   • Either PCV20 alone OR
   • PCV15 followed by PPSV23 (≥1 year later for most adults; ≥8 weeks later for immunocompromised) 1, 3
   • PCV21 is now also an option (as of 2024) 1

2. For adults who have started but not completed their pneumococcal vaccine series:

   • Those who received PCV13 but not PPSV23: Complete with either PCV20, PCV21, or PPSV23 1
   • Those who received PCV15 but not PPSV23: Complete with either PCV20, PCV21, or PPSV23 1
   • Those who received PPSV23 but no PCV: Can receive PCV15, PCV20, or PCV21 (≥1 year after PPSV23) 1

Regional Considerations for PCV21

The CDC provides specific guidance regarding PCV21 use:

• PCV21 lacks serotype 4, which is prevalent in certain western US regions (Alaska, Colorado, Navajo Nation, New Mexico, Oregon)
• In these regions with high serotype 4 prevalence, PCV20 or PCV15+PPSV23 may provide better coverage 1
• In other regions, PCV21 offers coverage against 8 additional serotypes not in previous vaccines 1

Administration Considerations

• Route of administration:

  • PCVs (PCV13, PCV15, PCV20, PCV21): Intramuscular only
  • PPSV23: Either intramuscular or subcutaneous 1

• Dosage:

  • All pneumococcal vaccines: 0.5 mL 1, 2

• Storage:

  • Refrigerated at 2°C to 8°C (36°F to 46°F)
  • Do not freeze 2

Contraindications

• Severe allergic reaction to any component of the vaccine
• For PCVs: Severe allergic reaction to any diphtheria toxoid-containing vaccine 1

Key Clinical Pitfalls to Avoid

1. Incorrect sequencing: Administering PPSV23 before PCV can diminish response to subsequent PCV administration 3

2. Ignoring regional epidemiology: Failing to consider regional pneumococcal serotype prevalence, particularly serotype 4 in western US regions when selecting between PCV21 and other options 1

3. Overlooking special populations: Transplant recipients require specialized schedules with multiple doses at specific intervals 3

4. Inadequate intervals between vaccines: Not maintaining proper timing between sequential vaccines can reduce effectiveness 1, 3

5. Storage errors: Freezing pneumococcal vaccines renders them ineffective 2

By understanding the available pneumococcal vaccines and following current ACIP recommendations, healthcare providers can optimize protection against pneumococcal disease for their patients.