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ClinicalThought: Pneumococcal Immunization
Updates on Pneumococcal Vaccines: My Take on the Latest IDWEEK 2021 Data

Released: November 19, 2021

Expiration: November 18, 2022

Paul G. Auwaerter
Paul G. Auwaerter, MD
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Provided that the Advisory Committee on Immunization Practices (ACIP) addressed novel pneumococcal immunizations in October 2021, I’d like to share my thoughts on several relevant studies presented at IDWeek 2021 that were particularly interesting. These studies include examinations of a new pneumococcal disease vaccination strategy in adults, healthcare professional preferences with regard to ACIP pneumococcal vaccination recommendations, and the results of 2 phase III trials with the 15-valent pneumococcal conjugate vaccine (V114) in children.

V114 in Adults
The PNEU-DAY study showed that the 15-valent conjugate vaccine V114 (recently approved by the FDA in adults), followed 6 months later by the polysaccharide 23-valent vaccine (PPSV23), was immunogenic and well tolerated in participants 18-49 years of age. V114 contains 2 additional serotypes, 22F and 33F, that are not included in the 13-valent conjugate vaccine. Of note, serotypes 3, 22F, and 33F are associated with an increasing and substantial number of cases of invasive pneumococcal disease. I think that the PNEU-DAY study shows these vaccines perform as hoped, eliciting antibody responses in adults. However, there are no randomized controlled studies of the clinical efficacy or outcomes of V114. As usual with many vaccine studies, the comparison is with earlier vaccines, and the study depends on observed surrogate serologic responses.

V114 in Infants and Children
Currently, V114 is approved in adults only, not in children who remain with the current recommendation to receive the PCV13 vaccine. The results of 2 phase III clinical trials with V114 in infants and children were also presented at IDWeek 2021. In the PNEU-DIRECTION trial, Bili and colleagues showed that V114 alone and in mixed-dose regimens with PCV13 was safe and generated similar immune responses in infants. In the PNEU-PLAN trial, Banniettis and colleagues found that V114 and PCV13 given as a “catch-up vaccination” was well tolerated, safe, and immunogenic in pneumococcal vaccine–naive children aged 7 months to 17 years. These 2 trials show that the V114 vaccine performs well in these pediatric age groups, including the additional 22F and 33F serotype responses.

Pneumococcal Vaccination Recommendations
I find that many of my colleagues are unaware of why the ACIP has changed pneumococcal vaccine recommendations over recent years. For example, what is the basis for these changes, or why there is now an additional updated recommendation? We do not see pneumococcal disease or invasive disease as frequently as we have in the past, possibly because people smoke less and efforts have been made to immunize children against pneumococci. The thought process of some healthcare professionals may be that 2 vaccines have to be better than one. However, cost-effectiveness studies found that using conjugate vaccines in adults to provide a quality-adjusted life-year can cost more than

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