The History of the Pneumococcal Vaccine

The first pneumococcal vaccine, Pneumovax 14, was approved for use in the United States in 1977. It was a polysaccharide vaccine that contained 14 different strains of streptococcus pneumoniae—of which there are about 100 different serotypes. That first vaccine was replaced in 1983 by another polysaccharide vaccine that contained even more serotypes, Pneumovax 23, PPSV23, which covers 23 strains accounting for most cases of invasive disease—including bacterial pneumonia, bacteremia, and meningitis—and is still in use today for some patient populations.

Science marched on, and in 2000, a new, structurally distinct “conjugate” vaccine was approved, Prevnar 7, PCV7, followed in 2008 by PCV13, which is still given as part of routine childhood vaccinations and to adults with additional risk factors or indicators.

Conjugate vs Polysaccharides

Conjugate vaccines are more robust than the polysaccharide vaccine. They prompt a stronger and more lasting immune response, but they cover fewer serotypes. So, to assure the broadest coverage and strongest immune response, the Centers for Disease Control and Prevention (CDC) had recommended PCV13, a conjugate vaccine, for all children to give long-lasting and robust coverage of the most common strains. For adults 65 and older, who suffer 80% of invasive pneumococcal disease, PPSV23, remained the recommended vaccine, as it covers a greater number of bacterial strains than the conjugate PCV13.

But these recommendations have caveats. For persons 2 and older with certain medical conditions, such as heart disease or diabetes, both vaccines are recommended, with the conjugate vaccine given first, followed by PPSV23. In adults 65 and older, if doctor and patient choose, both vaccines also can be given, once again with the conjugate first followed by the broader polysaccharide, one year apart.

New Coverage, New Options

In October 2021, the Advisory Committee on Immunization Practices (ACIP), an expert panel of the Centers of Disease Control and Prevention (CDC), approved two new conjugate vaccines, PCV15, made by Merck, and PCV20, made by Pfizer.

“We were already giving PCV13 followed by PPSV23, and now we have new kids on the block,’’ says Dr. Wanda Filer, Chief Medical Officer at VaxCare. “The new recommendation is PCV 15 plus PPSV23, or PCV 20 alone. You can do just the PCV 20 and get a strong response against the 20 serotypes in the vaccine, but three strains will remain uncovered.’’

While Prevnar13 is approved for children and adults, she says, the new vaccines—Merck’s PCV 15, called Vaxneuvance, and Pfizer’s Prevnar 20—are for adults only, at least until pediatric studies are reported, possibly within a year. This may add to the complexity of recommendations.

We were already giving PCV13 followed by PPSV23, and now we have two new kids on the block: PCV 15 plus PPSV23, or PCV 20 alone.

Results of those studies are eagerly anticipated, especially given the significant public health impact seen with the first wave of childhood vaccination to prevent pneumococcal infection, Dr. Filer says. “Once we started immunizing children against pneumococcal in 2000, it became clear the vaccine was highly effective,’’ she says. “Rates of illness in children improved dramatically, plunging 90% since 2008, according to the CDC, and we don’t see nearly the number of ear infections we used to.”

But the impact went beyond children’s health, resulting in a spillover effect that also has reduced the rate of disease in adults, she adds. “The vaccine lowered the number of bacteria in children’s noses, so when they hugged their grandparents and teachers, they were less likely to pass along infection,’’ she says. With routine vaccination of children, “the actual amount of pneumococcal disease in older adults dropped precipitously,’’ she says. Because of that, in 2019, the ACIP changed its recommendation for people 65 and older from a two-vaccine regimen to “shared decision making’’ on whether to administer PCV13 in addition to PPSV23.

All the changes can be perplexing for patients and clinicians alike, says Dr. Filer. “As a physician,’’ she says, “it can be incredibly confusing with several different pneumococcal vaccines in the refrigerator. We find it is not uncommon in a busy practice for somebody to pull out the wrong vial.’’

The ACIP always strives to balance public health with the economic realities associated with the cost of new vaccines, Dr. Filer says, and as new data comes in, more changes may be coming. Stay tuned.

The post New Pneumococcal Vaccines: Important Facts to Know appeared first on VaxCare.

That’s why, as a service to our partners (and any other interested parties, welcome!), we’re going to start providing a regular summary of the changes and additions to the 2023 immunization schedule from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) meeting, the most recent of which was held in October 2022.

Child and Adolescent Immunization Schedule Changes

In October 2022, the ACIP made changes to the 2023 immunization schedule for children and adolescents that include new or updated recommendations for the COVID-19 vaccine and pneumococcal conjugate vaccine. 

Updated Recommendations for Pneumococcal Vaccine
(The CDC’s VaxAdvisor app is a great resource for figuring out which pneumo vaccine to give your patients and when.)

• PCV15 has been added to the routine immunization schedule: language was added stating that 13-valent pneumococcal conjugate vaccine (PCV13) and PCV15 can be used interchangeably in both healthy children and those with any risk for invasive pneumococcal disease.
• Language for the minimum interval between doses 3 and 4 has been revised to clarify when a fourth dose is indicated. The text now reads “This dose is only necessary for children aged 12–59 months regardless of risk, or aged 60–71 months with any risk, who received 3 doses before age 12 months.”

Updated Recommendations for COVID-19 Vaccine

• A new row has been added with the columns for age 6 months–18 years highlighted in yellow to indicate the recommended age for COVID-19 vaccine (available here).
• A new section was added to provide additional details on the use of COVID-19 vaccines. The Routine Vaccination section describes the recommendations for primary series in the general population, and the Special Situations section describes the recommendations for primary series in persons who are moderately or severely immunocompromised. For booster dose vaccination in all populations, and guidance for Janssen (Johnson & Johnson) COVID-19 vaccine recipients, hyperlinks are included referring healthcare providers to the latest guidance. In addition, hyperlinks to the current COVID-19 vaccination schedules, use of COVID-19 preexposure prophylaxis in persons who are moderately or severely immunocompromised, as well as Emergency Use Authorization indications for COVID-19 vaccines, have been added.

Adult Immunization Schedule Changes

In October 2022, the ACIP made changes to the 2023 immunization schedule for adults that include new or updated recommendations for influenza vaccines and pneumococcal vaccines.

Updated Recommendations for Influenza Vaccine

• Information was added to the routine vaccination section for persons aged ≥65 years stating that any one of quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred for this age group.

Updated Recommendations for Pneumococcal Vaccine
The section has been substantially updated to reflect ACIP’s new recommendations for the use of PCV15 and PCV20 in persons who previously received pneumococcal vaccines. (The CDC’s VaxAdvisor app is a great resource for figuring out which pneumo vaccine to give your patients and when.)

• For those who have not previously received a dose of PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose PCV15 OR 1 dose PCV20. If PCV15 is used, this should be followed by a dose of PPSV23 given at least 1 year after the PCV15 dose. A minimum interval of 8 weeks between PCV15 and PPSV23 can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak to minimize the risk of invasive pneumococcal disease caused by serotypes unique to PPSV23 in these vulnerable groups.
• For those who have previously received both PCV13 and PPSV23, AND PPSV23 was received at age 65 years or older, based on shared clinical decision-making, 1 dose of PCV20 should be administered at least 5 years after the last pneumococcal vaccine dose.
• For those who have previously received only PCV13, 1 dose PCV20 at least 1 year after the PCV13 dose OR complete the recommended PPSV23 series as described here.

The post ACIP Roundup: Changes to the 2023 Immunization Schedule (Oct 2022) appeared first on VaxCare.

Updated Recommendations for Recombinant Zoster Vaccine

ACIP voted to recommend two doses of recombinant zoster vaccine (Shingrix: GlaxoSmithKline/GSK) for adults age 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy. For immunocompetent adults, Shingrix is intended to be administered in two doses, two to six months apart. However, for adults who are or will be immunodeficient or immunosuppressed due to known disease or therapy and who would benefit from a shorter vaccination schedule, the second dose can be administered one to two months after the first dose.

Updated Recommendations for Hepatitis B Vaccine

ACIP now recommends that the hepatitis B vaccine be given to all adults through age 59 and adults age 60 and older with any risk factors for HBV infection, following the celebrated vote on this matter in November of 2021. This update serves as a natural extension of the existing routine childhood recommendations and helps to address the 20,700 acute hepatitis B infections in the U.S. every year. It’s also in keeping with the goal of the CDC’s Division of Viral Hepatitis to reduce HBV infections by 90% and HBV-related deaths by 65% by 2030.

There’s lots more to know in another busy year of vaccines. Our Vaccine Roadmap 2022 has this and other important information to keep you informed and your patients protected. See below to download your copy.

The post What’s New in Adult Vaccines 2022 appeared first on VaxCare.

…it’s going to be important for physicians to get their patients back in the office and catch everyone up so we avoid outbreaks of other diseases.

One effect of the 2020 pandemic is the dramatic downturn in patients coming in for well-checks and other preventative visits, which has the trickle-down effect of missed vaccinations.“We’ve seen tremendous loss in traditional immunization coverage rates,” says Dr. Tan. “The rates are particularly abysmal in adolescents and adults. As the COVID-19 vaccine becomes more available and the pandemic comes to a close, it’s going to be important for physicians to get their patients back in the office and catch everyone up so we avoid outbreaks of other diseases.”

As patients start to come back in for catch-ups, practices will want to ensure their fridges are stocked with the new and updated vaccines that represent the best standard in care for their patients.

Some of the most notable changes and additions to the CDC’s Advisory Committee on Immunization Practices (ACIP) 2021 immunization schedule are:

Vaxelis

Vaxelis (Sanofi/Merck) is a pediatric hexavalent vaccine that includes antigens for diphtheria, tetanus, pertussis, and poliomyelitis, as well as antigens for H. influenzae type b and hepatitis B.

MenQuadfi

MenQuadfi (MenACWY/Sanofi) is the first FDA-approved quadrivalent meningococcal vaccine that uses tetanus toxoid as a protein carrier, demonstrates a high immune response across all four serogroups, and helps protect an expanded age group, protecting both younger and older patients than previous offerings.

Zostavax Off the Schedule; Shingrix Fully Available.

As of November, 2020, Zostavax (Merck) is no longer available for use in the United States. The only shingles vaccine on the 2021 schedule is Shingrix (GlaxoSmithKline/GSK), the recombinant zoster vaccine that was licensed by the FDA in October, 2017 and is recommended for patients 50 years and older. Though there were troubling shortages of Shingrix in 2019, there is no indication of a shortage in 2021; however, GSK did raise prices on Shingrix by 7% for the coming year.

VaxCare keeps your vaccine fridge stocked with the most up-to-date vaccines from all major manufacturers and automatically replenishes your inventory when supply gets low. Get in touch today to learn more about how our automated vaccine platform streamlines your vaccine workflow, reduces errors, and takes care of billing, leaving you more time to do what you love most—care for your patients.

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