PNEUMONIA VACCINE SIMPLIFIED!

Well, what do you know?! Finally something in medicine is simpler. Finally, instead of a confusing, multi-drug treatment regimen, a single drug has been introduced that is effective against an infectious disease that plagues individuals over age 65.

I’m referring to the vaccines approved in 2021 for the prevention of infections caused by the numerous strains of pneumococcal bacteria, or what’s commonly called Pneumonia Vaccine. Actually, two new pneumococcal vaccines were approved last year: PCV15 (Vaxneuvance) and PCV20 (Prevnar 20). There are now four varieties of pneumonia vaccine. The Advisory Committee on Immunization Practices (ACIP) has incorporated these new vaccines into their recommendations for individuals over age 65. They boast that “the new guidelines” for the use of PCV15 and PCV20 “come close” to perfection. “If a clinic wants to stock only one pneumococcal vaccine for adults, the PCV20 vaccine could meet the needs of all adult patients.”

Prior to last year, complicated regimens using the available vaccines were used, but not without confusing both patients and doctors. PCV13 (Prevnar 13) and PPSV23 (Pneumovax), in various combinations and sequences, were both given routinely. However, a significantly high percentage of pneumococcal strains were not being covered by these two vaccines. The introduction and use of PCV20 covers all but 8% of invasive pneumococcal bacterial strains. If this 8% were a concern to a patient, or the physician, giving a dose of PPSV23 will cover that risk.

Some patients have already received Pneumovax (PPSV23) or Prevnar 13 (PCV13) so adding new vaccines have altered the guidelines. The new guidelines are listed below:

1. Adults who have received Pneumovax 23 alone, should receive PCV15 or PVC20 at least one year after Pneumovax.
2. Adults who have received Prevnar 13 alone, should receive Pneumovax 23 at least one year later.
3. Adults who have received both Prevnar 13 and Pneumovax 23, need no additional vaccination
4. Adults age 65 and older should receive either PCV20 once, alone, or PVC15 followed one year later by Pneumovax 23. 
5. Adults with high risk conditions** should receive one dose of PCV20 or a combination of PCV15 plus Pneumovax 23. 

** High risk conditions: smoking, alcoholism, diabetes mellitus, heart disease, liver disease, lung disease, kidney failure, absence of a spleen, immunodeficiencies, widespread malignancy, HIV, lymphoma, leukemia, sickle cell disease, organ transplant, cochlear implant, others. 

“Both PCV15 and PCV20 are expected to be safe and well-tolerated, with no serious adverse events noted in clinical trials.”

Dr. G’s Opinion: These new vaccines sound good! I hope they are, but in all the years I gave Pneumovax, I cannot recall a single adverse reaction. Previous pneumococcal vaccines were worry-free for the doctor. I hope the new ones are, too. PCV20’s efficacy against 92% of pneumococcal strains is very good. Having one vaccine that covers just about everything makes deciding what to give much easier. It’s certainly better than the efficacy of COVID-19 vaccines. If you have already had 13 and 23, you’re in good shape. You need nothing. However, new, unvaccinated seniors should get PCV20 or the PCV15/PPSV23 combination.

Reference: Shah AA. Simplifying Pneumococcal Immunizations for Adults.  Am Fam Phys 2022 June;105(6):580-581.