Is there a live pneumococcal vaccine available?

Pneumococcal Vaccines: No Live Options Available

There are no live pneumococcal vaccines available for clinical use. All currently licensed pneumococcal vaccines are either polysaccharide or conjugate vaccines, not live attenuated vaccines 1.

Types of Available Pneumococcal Vaccines

Currently, four pneumococcal vaccines are licensed and available in the United States:

1. PPSV23 (Pneumovax23) - 23-valent pneumococcal polysaccharide vaccine

   • Contains purified capsular polysaccharide antigens from 23 serotypes
   • FDA approved for adults ≥50 years and persons ≥2 years at increased risk 1, 2
   • Administered intramuscularly or subcutaneously 1

2. PCV13 (Prevnar13) - 13-valent pneumococcal conjugate vaccine

   • Contains 13 pneumococcal serotypes conjugated to CRM197 carrier protein
   • FDA approved for adults ≥18 years 2
   • Administered intramuscularly 1

3. PCV15 (Vaxneuvance) - 15-valent pneumococcal conjugate vaccine

   • Contains all PCV13 serotypes plus 22F and 33F
   • FDA approved for persons aged ≥6 weeks 2
   • Administered intramuscularly 1

4. PCV20 (Prevnar20) - 20-valent pneumococcal conjugate vaccine

   • Contains 20 pneumococcal serotypes
   • FDA approved for adults ≥18 years 2, 3
   • Administered intramuscularly 1

Mechanism of Action

Unlike live vaccines which contain attenuated pathogens that replicate in the body, pneumococcal vaccines work through different mechanisms:

• Polysaccharide vaccines (PPSV23): Contain purified capsular polysaccharide antigens that induce B-cell responses through T-cell independent mechanisms. They do not create immunological memory and don't affect nasopharyngeal carriage 1.

• Conjugate vaccines (PCV13, PCV15, PCV20): Contain polysaccharide antigens conjugated to a carrier protein (CRM197), which elicits a T-cell dependent immune response. This results in higher affinity antibodies and immunological memory 1.

Current Recommendations

The Advisory Committee on Immunization Practices (ACIP) recommends:

• For adults ≥65 years and adults 19-64 years with certain underlying conditions: Either PCV20 alone or PCV15 followed by PPSV23 3

• For immunocompromised patients: Pneumococcal vaccination is strongly recommended, with specific schedules depending on prior vaccination history 1

Safety Considerations

All pneumococcal vaccines have demonstrated good safety profiles in clinical trials:

• Local reactions and systemic events are generally mild to moderate
• Serious adverse events are rare 4, 5

Important Clinical Considerations

1. Storage: All pneumococcal vaccines should be refrigerated at 2-8°C (36-46°F) and never frozen 2

2. Contraindications: Severe allergic reaction to any vaccine component or to diphtheria toxoid-containing vaccines 2

3. Cost-effectiveness: PCV20 has been shown to be highly cost-effective compared to no vaccination and cost-saving compared to sequential PCV15+PPSV23 regimens 6

4. Timing with other vaccines: Can be administered concurrently with other vaccines, including influenza vaccine 1

In conclusion, while there are multiple pneumococcal vaccine options available with proven efficacy and safety profiles, none of them are live vaccines. The choice between available options should be based on patient age, risk factors, and prior vaccination history.