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Pneumococcal Vaccine Recommendations
So Many Formulations: Pneumococcal Vaccines and Recommendations

Released: November 12, 2024

Expiration: November 11, 2025

Richard H. Dang
Richard H. Dang, PharmD, APh
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Key Takeaways
  • PCV15, PCV20, PPSV23, and PCV21 are the current pneumococcal vaccines, but new formulations, while providing better coverage, could create confusing recommendations.
  • Providers need to continue to provide education and strong recommendations for indicated populations.

Pneumococcal vaccines can be confusing for many providers, especially considering that there have been  several changes to the types of formulations that have come on and off the market, as well as changing recommendations. It is reasonable for providers to be confused as to what the current recommendations are.

Pneumococcal Vaccine Formulations
PCV15, PCV20, PPSV23, and then the newest one, PCV21, are the pneumococcal vaccines available for adults.  Looking into the pipeline, there are additional formulations (a 24-valent and 31-valent vaccine) that are being developed and studied, causing even more confusion on when to use which formulation and under which circumstances. Previously available vaccines that have been replaced include PPSV14, PCV7, and PCV13.

The pneumococcal vaccines are intended to help prevent and reduce the severity of invasive pneumococcal disease (IPD), which can lead to conditions such as pneumonia, bacteremia, or meningitis. Streptococcus pneumoniae are common inhabitants of the respiratory tract. There are over 100 different serotypes of S. pneumoniae that can cause these different infections and diseases, necessitating new vaccines to cover additional bacterial strains are as non-vaccine serotypes become more prevalent. 

To this end, the development of new vaccines aims for broader coverage of more bacterial strains. Older vaccines targeted the most common serotypes at the time, but other serotypes have since become more responsible for causing different diseases, which are not being covered by prior vaccines. 

PPSV14 and PCV7 were the first pneumococcal vaccines for adults and children, respectively, and they provided coverage against only 14 and 7 of the 100 different serotypes of the bacterium. Currently there are PCV15, PCV20, PCV21, and PPSV23 (which cover against 15, 20, 21, and 23 serotypes, respectively). There are some differences as far as which serotypes are being covered across the different products, but the vaccines that we have available now cover the vast majority of bacteria that are causing IPD.

Pneumococcal Vaccine Recommendations Across Different Ages
The pneumococcal vaccine is used across a variety of populations mostly delineated by age: children, older adults, and high-risk adults.

In the pediatric population, it is a routine primary series used as protection against the pneumococcal disease as children age.

For older adults the vaccine should also be routine, because pneumococcal infections, like pneumonia and meningitis, are most common in the elderly population. This population is at the greatest risk for acquiring infection and having major complications that could affect quality of life. Of note, in October 2024, the CDC Advisory Committee on Immunization Practices (ACIP) recommended lowering the age for routine pneumococcal vaccination from 65 to 50 years old, based on data regarding when the risk of infection increases substantially. I believe that lowering the recommended age for vaccination will provide more opportunities for adults to protect themselves from infection and lower the overall risk of infection for others they come in contact with.

In addition, adults aged 19-59 years should receive a vaccine if they are classified as high risk due to comorbidities, which includes people with diabetes, lung disease, or heart disease, and cigarette smokers. The vast majority of deaths from pneumococcal disease are in adults, but there are a lot of missed opportunities to provide pneumococcal vaccination to high-risk adults aged 19-59 years. Whether practicing in a community pharmacy, hospital, or primary care clinic, identifying eligible patients and encouraging them to receive the vaccine could require education about the potential risks and benefits of receiving the vaccine.  

Being protected against 1 serotype does not necessarily provide protection against another. Being vaccinated or previously infected may not convey immunity to other serotypes. So, I still recommend the pneumococcal vaccine to people who previously received a pneumococcal vaccine. There are different recommendations for patients who are vaccine naive and those who have received older formulations of the vaccine, so I would evaluate what vaccines a patient previously received before giving them a new one. But broadly speaking, I think everyone should receive the PCV15 plus PPSV23, PCV20, or PCV21 vaccines to broaden the scope of protection against the types of bacteria that are most common today.

New Advances in the Pneumococcal Vaccines
It is important to stay up to date with current guidelines to make sure the patient is getting the best product possible. A strong healthcare provider recommendation is a strong factor for patients deciding to receive vaccines. In the context of vaccine hesitancy and confusion, a strong recommendation from a trusted provider means a lot to patients. 

I think it is exciting that the vaccine products are continually evolving to offer greater protection. There is a lot to look forward to over the next few years with products in the pipeline that will expand serotype coverage even more.  As a goal, I would want to see as close to 100% coverage across all serotypes, which we may see with new products.

To help navigate new developments in pneumococcal vaccines and recommendations, I encourage you to join me and my colleagues, Dr. Jeffrey Goad and Dr. Mary Bridgeman, at a live symposium, which you can join in person or online on December 10th. In the meantime, I think it’s also helpful to be in tune with what the CDC is doing. At a minimum, the CDC releases new recommendations every year, with new updated routine vaccine recommendations. Healthcare providers should always refer to the ACIP for the annual immunization schedules for the current calendar year and periodically check for new recommendations in the addendum. 

Your Thoughts?
How often are you educating and providing any of the pneumococcal vaccines to your patients? Get involved in the discussion by posting a comment below.