Is Prevnar 20 (pneumococcal conjugate vaccine) recommended for Chronic Obstructive Pulmonary Disease (COPD) patients who have already completed the pneumonia vaccine series with Prevnar 13 (pneumococcal conjugate vaccine) and Pneumovax 23 (pneumococcal polysaccharide vaccine)?

Prevnar 20 Recommendations for COPD Patients Who Have Completed Prevnar 13 and Pneumovax 23

For COPD patients who have already completed the pneumococcal vaccination series with Prevnar 13 and Pneumovax 23, shared clinical decision-making is recommended regarding administration of Prevnar 20, with the vaccine being an option if 5 or more years have passed since the last pneumococcal vaccination. 1

Background and Rationale

COPD is considered a chronic medical condition that increases the risk of pneumococcal disease. Patients with COPD have historically been recommended to receive pneumococcal vaccination due to their increased susceptibility to respiratory infections and potential for severe complications.

Current Evidence for Patients Who Completed Previous Vaccine Series

The 2023 Advisory Committee on Immunization Practices (ACIP) recommendations provide specific guidance for adults who have completed the previously recommended pneumococcal vaccine series:

• For adults who have already received both PCV13 and PPSV23, the remaining risk depends on:

  • Risk of exposure to serotypes contained in PCV20
  • Presence of underlying medical conditions (like COPD)
  • Time since last pneumococcal vaccination 1

• Clinical trial data shows that PCV20 is safe and immunogenic in adults who previously received both PCV13 and PPSV23 1

• The FDA label for Prevnar 20 notes that receipt of PPSV23 1-5 years prior to Prevnar 20 resulted in diminished immune response compared to other vaccination sequences 2

Recommendation Algorithm for COPD Patients

For COPD patients who have completed both PCV13 and PPSV23:

1. If it has been ≥5 years since the last pneumococcal vaccine dose:

   • Consider a single dose of PCV20 based on shared clinical decision-making 1

2. Factors to consider in the decision-making process:

   • Patient's age (those <65 years may benefit more)
   • Severity of COPD (more severe disease increases risk)
   • Time since last pneumococcal vaccination (longer intervals may warrant revaccination)
   • Risk of exposure to pneumococcal serotypes 1

3. If PCV20 is administered:

   • No additional pneumococcal vaccines are needed after PCV20 1

Benefits and Considerations

• Potential benefits: PCV20 provides coverage for 7 additional serotypes beyond PCV13, offering broader protection against pneumococcal disease 3

• Immune response considerations: Phase III clinical trials demonstrated that PCV20 use is safe and immunogenic in adults who previously received both PCV13 and PPSV23 1

• Timing considerations: The optimal timing for PCV20 administration is ≥5 years after the last pneumococcal vaccine dose 1

Common Pitfalls and Caveats

• Avoid administering PCV20 too soon: Administering PCV20 less than 5 years after the last pneumococcal vaccine dose may not provide optimal benefit 1

• Consider age-specific recommendations: Vaccine effectiveness may vary by age, with potentially greater benefit in younger patients with COPD 4

• Drug interactions: Be aware that immunosuppressive therapies may reduce the immune response to PCV20 2

• Prior PPSV23 timing impact: Receipt of PPSV23 1-5 years prior to Prevnar 20 results in diminished immune response compared to other vaccination sequences 2

Conclusion

For COPD patients who have already completed the pneumococcal vaccination series with Prevnar 13 and Pneumovax 23, a single dose of Prevnar 20 may be considered through shared clinical decision-making if at least 5 years have passed since the last pneumococcal vaccination. The decision should take into account the patient's individual risk factors, severity of COPD, and time since previous vaccination.