Issue 1759: May 30, 2024

• Q: What are the major changes in the ACIP recommendations for pneumococcal vaccination of children published by CDC on September 29, 2023? 
• Q: What are the main differences between pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccines (PCVs)? 
• Q: When is pneumococcal polysaccharide vaccine (PPSV23) recommended as an option for children? 
• Q: How do we account for the history of PCV7 vaccination when determining the pneumococcal vaccination needs of an older teen or young adult with a high-risk condition? 

A: Both PCV15 and PCV20 are now recommended as pneumococcal vaccination options for children age 6 weeks and older as well as for older children age 6 through 18 years with certain medical conditions or other risk factors for pneumococcal disease. ACIP no longer recommends PCV13 for children or adults; however, PCV13 may be given as previously recommended if it is the only PCV available and the recipient would otherwise go without vaccination. Pneumococcal polysaccharide vaccine (PPSV23) is recommended as an option for some children age 2 years and older who have certain underlying medical conditions and who have not had (or do not have the option of receiving) PCV20.
 
Details of the recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7239a5-H.pdf (for PCV20) and www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7137a3-H.pdf (for PCV15). These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html.

A summary of these recommendations can also be found at www.immunize.org/wp-content/uploads/catg.d/p2016.pdf. Immunize.org has developed standing orders for pneumococcal vaccination of children and teens at www.immunize.org/wp-content/uploads/catg.d/p3086.pdf.

A: The polysaccharide vaccine includes the different polysaccharides (chains of complex sugars) from different serotypes as the antigen. The conjugate vaccines have the polysaccharides for different serotypes attached (or conjugated) to a carrier protein. The immune response to the PPSV23 vaccine is a T-cell independent immune response, while the immune response to PCV vaccination is a T-cell dependent response that produces memory B-cells and reduces carriage of the bacteria in the respiratory track. The PPSV23 does not reduce bacterial carriage.

A: PPSV23 has only limited indications in children age 2 through 18 years who have not had PCV20 and are at high risk for serious pneumococcal infection due to the presence of a specific non-immunocompromising (non-IC) or immunocompromising (IC) medical condition.
 
If PCV20 is not offered, PPSV23 is recommended as an option to be administered to a child age 2 years or older at least 8 weeks following completion of PCV vaccination with PCV13 or PCV15. If a child has an immunocompromising condition and PPSV23 is used, a dose of PCV20, or a second dose of PPSV23, should be given 5 years later.
 
Immunize.org details all recommendations and pneumococcal vaccine options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens (www.immunize.org/wp-content/uploads/catg.d/p3086.pdf) and its shorter resource, Recommendations for Pneumococcal Vaccines Use in Children and Teens (www.immunize.org/wp-content/uploads/catg.d/p2016.pdf).

A: Because of the limited number of serogroups covered by PCV7 (which was used in the United States between 2000 and 2010), CDC recommends that doses of PCV7 should be ignored for the purposes of calculating the current pneumococcal vaccination needs of an older teen or adult patient at increased risk for pneumococcal disease. For example, a person at high risk of pneumococcal disease who received a complete series of PCV7 vaccination in early childhood should follow the vaccination recommendations for someone with their condition who has not received any doses of pneumococcal conjugate vaccine.