Clarify New Guidelines for Prevnar 20 and Vaxneuvance

You'll need to know which adults should get one of the new pneumococcal vaccines, Prevnar 20 or 15-valent Vaxneuvance...and when.

These conjugate vaccines may lead to longer-lasting and better immunity than Pneumovax 23 polysaccharide vaccine. CDC projects the new vaccines will reduce overall pneumococcal disease and healthcare costs.

This is leading to changes in pneumococcal guidelines for adults 65 and up...or 19 to 64 with risk factors (cancer, diabetes, smoking, etc).

CDC now recommends that these patients get Prevnar 20 alone...OR Vaxneuvance PLUS Pneumovax 23, usually after 1 year...depending on risk factors and vaccine history. After that, no boosters are needed.

Explain that Pneumovax 23 is given in addition to Vaxneuvance to broaden coverage. About 15% of invasive pneumococcal disease is caused by the 5 serotypes in Prevnar 20 that aren't in Vaxneuvance.

Expect Prevnar 20 or Vaxneuvance to cost about $230...Pneumovax 23 is $120. All will be covered by Medicare Part B.

Guidelines don't prefer one strategy over another.

But lean toward Prevnar 20 as more practical and less costly...since patients getting Vaxneuvance also need Pneumovax 23.

Consider a simplified approach.

No prior pneumococcal vaccines...give 1 dose of Prevnar 20.

Prior Pneumovax 23 only...consider giving 1 dose of Prevnar 20 after 1 year.

Prior Prevnar 13 with or without Pneumovax 23...don't give Prevnar 20 or Vaxneuvance yet. There aren't data on whether giving one of the new vaccines on top of Prevnar 13 adds much benefit.

Stay tuned for guidance in these patients this year. For now, complete the prior Pneumovax 23 schedule...such as giving Pneumovax 23 to adults 65 and older 1 year after Prevnar 13.

Continue to emphasize pediatric vaccination...this also indirectly protects adults. Stick with Prevnar 13 for kids for now. But expect pediatric approval for Vaxneuvance this spring...and Prevnar 20 next year.

Give pneumococcal vaccines with other vaccines (COVID-19, etc) if needed. Data are limited, but CDC guidelines don't suggest a concern.

Bookmark our new algorithm, Pneumococcal Vaccination in Adults, to guide patient-specific decisions. And use our chart, Comparison of Pneumococcal Vaccines, for a side-by-side look at products.

Key References

  • MMWR Morb Mortal Wkly Rep. 2022 Jan 28;71(4):109-117
  • https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-10-20-21/02-Pneumococcal-Kobayashi-508.pdf (2-24-22)
  • Clin Infect Dis. 2021 Oct 5;73(7):e1489-e1497
  • Vaccine. 2021 Oct 15;39(43):6422-6436
  • Medication pricing by Elsevier, accessed Feb 2022
Pharmacist's Letter. March 2022, No. 380301



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