Pneumonia Vaccines

Whats the difference between PCV and PPSV?

PPSVs (pneumococcal polysaccharide vaccines) have been used for years, but not in young children who cant form antibodies to the antigens on PPSVs. PCVs (protein-conjugated polysaccharide vaccines) may provide longer duration of protection. PPSV23 (Pneumovax 23) Strains covered by PPSV23: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F FDA approved indications: Approved for use in persons 50 years of age or older and persons aged >2 years who are at increased risk for pneumococcal disease

PCV13 (Prevnar 13) Strains covered by PCV13: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F

FDA approved indications: For children 6 weeks through 17 years of age for the prevention of invasive disease caused by 13 Streptococcus pneumonia strains and for children 6 weeks through 5 years for the prevention of otitis media caused by 7 of the 13 strains (4, 6B, 9V, 14, 18C, 19F, and 23F) For adults 50 years of age and older for the prevention of pneumococcal pneumonia

ACIP** recommendations for adults: Adults aged 19 years or older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, CSF leaks or cochlear implants.

ACIP recommendations for adults: Adults 65 years or greater Anyone age 2 through 64 with a long term medical problem or who is immunocompromised Anyone aged 19 through 64 who has asthma or is a smoker

In adult patients who meet the criteria for each of the vaccinations, the ACIP recommends receiving both vaccines. The timeline is as follows: - For patients who have not received a PPSV 23 vaccination yet, it is recommended to receive the PCV 13 vaccine, followed by PPSV 23 vaccine 8 weeks later. (If a second dose of PPSV 23 is indicated it should be given at least five years after the first.) - For patients who have received a dose of PPSV 23, wait one year after last dose of PPSV 23 to administer the PCV 13. Give any remaining doses of PPSV 23 at least 5 years after the first and at least 8 weeks after the PCV 13 vaccine. ** Advisory Committee on Immunization Practices

Is the PCV 13 more effective than PPSV 23?

Summary: Prevnar 13 had statistically significant opsonophagocytic activity (OPA) values for eight of the twelve common serotypes in adult patients. In the package insert, it points out a very important aspect to this topic This indication is based on immune responses elicited by Prevnar 13. There have been no controlled trials in adults demonstrating a decrease in invasive pneumococcal disease or pneumococcal pneumonia after vaccination with Prevnar 13.2 It does cover the 6A serotype, unlike the PPSV 23 vaccine, which is known to be one of the more invasive and drug resistant strains.

As per CDC, percentage of invasive pneumococcal disease cases caused by serotypes covered in three different pneumococcal vaccine formulations (PCV7, PCV13, and PCV23) among adults aged 18 years, by age group --- Active Bacterial Core surveillance, United States, 2008

Medical indications: understanding the ACIP recommendations

Cost:
Prevnar 13 (PCV13): Supply cost: $153.64 Charge per dose: $336.16 Pneumovax 23 (PPSV 23): Supply cost: $61.16 Charge per dose: $160.64

My Conclusion: There is not enough information to determine if the increased OPA titers by PCV13 are more beneficial than the number of serotypes covered by the PPSV 23 vaccine at preventing disease. The PCV 13 vaccine does provide coverage for a particularly virulent strain that PPSV does not. At this point, PCV 13 place is not to replace PPSV 23, but to supplement it. Follow ACIP recommendations above and administer both vaccines if indicated. Results pending for infection rates with the use of PCV 13.

Works Cited/Recommended readings 1- Centers for Disease Control and Prevention (CDC).Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012 Oct 12;61(40):816-9. 2- Jackson LA, Gurtman A, van Cleeff M, Jansen KU, Jayawardene D, Devlin C, Scott DA, Emini EA, Gruber WC, Schmoele-Thoma B. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine compared to a 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine-naive adults. Vaccine. 2013 Aug 2;31(35):3577-84. 3- Prevnar 13 [Package insert]. Philadephia (PA): Pfizer. Available online: http://labeling.pfizer.com/showlabeling.aspx?id=501 4- Splete H. ACIP considers recommending PCV13 for adults. Internal Medicine News. http://www.internalmedicinenews.com/news/infectious-diseases/single-article/acip-considersrecommending-pcv13-for-adults/3593bc5535.html 5- MMWR: Morbidity and Mortality Weekly Report. June 1, 2012. Centers for Disease Control and Prevention (CDC). Licensure of 13-Valent Pneumococcal Conjugate Vaccine for Adults Aged 50 Years and Older. .MMWR Morb Mortal Wkly Rep. 2012 Oct 12;61(40):816-9. 6- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance Reports, Emerging Infections Program Network, Streptococcus pneumoniae. http://www.cdc.gov/abcs/reportsfindings/surv-reports.html; Published [accessed 2013, Oct 24].