Is the pneumococcal 21 (Prevnar 21) vaccine available for adults 65 years and older or those with underlying health conditions?

Yes, the Pneumococcal 21-Valent Vaccine (PCV21/CAPVAXIVE) is Available

Yes, the pneumococcal 21-valent conjugate vaccine (PCV21, brand name CAPVAXIVE) was FDA-licensed on June 17,2024, and recommended by ACIP on June 27,2024, as an option for adults aged ≥19 years who are indicated for pneumococcal vaccination, including adults ≥65 years and those 19-64 years with underlying health conditions. 1

Who Should Receive PCV21

Age-Based Recommendations

• All adults aged ≥65 years should receive a pneumococcal conjugate vaccine, with PCV21 now available as one option alongside PCV20 or PCV15 1, 2
• Adults aged 50-64 years are now recommended to receive a single dose of PCV (including PCV21 as an option) as of October 2024 3
• Adults aged 19-49 years with risk conditions (chronic heart/lung/liver disease, diabetes, alcoholism, smoking, immunocompromising conditions) should receive PCV21 or alternative pneumococcal vaccines 1, 2

Key Advantages of PCV21

• Contains eight unique serotypes not found in any other licensed pneumococcal vaccine (PCV15, PCV20, or PPSV23) 1
• During 2018-2022, these eight unique serotypes caused approximately 20-30% of invasive pneumococcal disease (IPD) cases among adults with vaccination indications 1
• A single dose completes the vaccination series with no additional doses needed 4

Critical Geographic Consideration: The Serotype 4 Issue

When PCV21 Should NOT Be Used

PCV21 lacks serotype 4, which is a major limitation in most U.S. regions. 1

• In the Midwestern, Eastern, and Southern United States, PCV20 is preferred over PCV21 because serotype 4 causes significant disease in these regions 1, 4
• Adults aged <65 years with risk factors (alcoholism, chronic lung disease, smoking, homelessness, injection drug use) in non-Western regions who develop serotype 4 IPD typically have not received prior pneumococcal vaccination 1
• In these populations, PCV20 alone or PCV15 + PPSV23 provide broader serotype coverage against locally circulating strains compared to PCV21 1

When PCV21 IS Preferred

In Alaska, Colorado, Navajo Nation, New Mexico, and Oregon, PCV21 is the preferred choice due to high percentages (≥30%) of IPD caused by serotype 4 in these specific regions 1, 4

Practical Algorithm for Vaccine Selection

Step 1: Determine Geographic Location

• Western U.S. (Alaska, Colorado, Navajo Nation, New Mexico, Oregon): Consider PCV21 as preferred option 1, 4
• All other U.S. regions: PCV20 is generally preferred due to serotype 4 coverage 1, 4

Step 2: Confirm Vaccination Indication

• Age ≥50 years (any adult) 3
• OR age 19-49 years with risk conditions 1, 2

Step 3: Administer Single Dose

• One dose of PCV21 (or PCV20) completes the series 4
• If PCV15 is chosen instead, PPSV23 must follow at least 1 year later (or 8 weeks for immunocompromised) 5

Common Pitfalls to Avoid

• Do not assume PCV21 is automatically superior because it has more serotypes—the absence of serotype 4 is clinically significant in most U.S. regions 4
• Do not overlook geographic epidemiology when selecting between PCV21 and PCV20 1
• Do not forget that cigarette smoking alone is an independent indication for pneumococcal vaccination (2.8-4.1 times increased IPD risk) 5
• Do not miss vaccination opportunities during hospital admissions or outpatient visits for adults ≥50 years 5

Safety Profile

• Contraindicated in persons with severe allergic reaction to any vaccine component or any diphtheria toxoid-containing vaccine 1
• Adverse events should be reported to VAERS 1, 2
• Safety monitoring is ongoing as this is a newly licensed vaccine 1