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Pneumococcal Vaccines
Pneumococcal Vaccines for Adults: A Matter of Choice?

Released: September 16, 2024

Expiration: September 15, 2025

Elisabeth Botelho-Nevers
Elisabeth Botelho-Nevers, MD, PhD, HDR
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Key Takeaways
  • Approved adult pneumococcal vaccines offer protection against invasive pneumococcal disease in specific populations based on serotype coverage.
  • New pneumococcal vaccines with broader serotype coverage are still needed because of the epidemiologic evolution of serotypes; this will allow for customization of vaccination based on local disease patterns.

New vaccines against invasive pneumococcal disease (IPD) must be developed because of the epidemiologic evolution of associated serotypes. Luckily, in the last few years, both the European Medicines Agency (EMA) and the FDA approved the pneumococcal 20-valent conjugate vaccine (PCV20), allowing better protection in adults and children. More recently, in June 2024, the FDA approved a pneumococcal 21-valent conjugate vaccine (PCV21), the first pneumococcal vaccine developed specifically for use in adults. 

PCV20 and PCV21 provide coverage for 10 of the same serotypes, but each also covers unique serotypes. PCV20 provides coverage for an additional 10 serotypes not covered by PCV21, such as serotype 4. Conversely, PCV21 provides coverage for an additional 11 unique serotypes not covered by PCV20. In fact, 8 of those 11 unique serotypes covered by PCV21 (15A, 15C, 15F, 23A, 23B, 24F, 31, 35B) are not covered by any other available pneumococcal vaccine.

Authorizations and Recommendations
Since 2018, the prevalence of PCV20 serotypes in European adults has accounted for approximately 60% of all pneumococcal isolates in IPD. Many European countries now recommend PCV20 in older adults or adults with risk factors. Other countries continue to follow the previous schedule of PCV13 and pneumococcal polysaccharide 23-valent conjugate vaccine (PPSV23). 

PCV21 marketing authorization is under review by the EMA’s Committee for Medicinal Products for Human Use. If authorized, PCV21 would allow for an additional adult pneumococcal vaccination option to improve serotype coverage specific to the individual.  

For insight on how PCV21 might be used, we can look to examples from the United States. In June 2024, the US Advisory Committee on Immunization Practices (ACIP) recommended PCV21 as an additional vaccine option for adults aged 19 years or older with current recommendations to receive a pneumococcal vaccine. Of note, ACIP has not yet made a recommendation regarding PCV21 for adults in the US aged 50-64 years who do not have a risk-based pneumococcal vaccine indication. This is expected to be voted on in fall 2024.

Coverage
What do we know about the coverage of pneumococcal serotypes thanks to these vaccines? Data presented at the June 2024 ACIP meeting showed that PCV21 provides 81% coverage of serotypes associated with IPD in adults aged 19-64 years who have a risk-based indication and 85% coverage for those aged 65 years or older. By contrast, PCV20 provides 58% coverage for those aged 19-64 years and 54% coverage for those aged 65 years or older.

Beyond coverage overall, specific coverage may also be a factor when choosing among vaccines. For example, in the United States, there has been an increase in the number of cases of IPD with serotype 4, in particular among people experiencing homelessness and adults in Alaska (especially Alaska Natives). But serotype 4 is not covered by PCV21—although PCV21 provides overall improved serotype coverage, it does not cover an emerging serotype causing disease in these specific subpopulations.

This demonstrates how, with multiple vaccines available, the choice of adult pneumococcal vaccines potentially may be individualized, allowing us to choose among vaccines based on which serotypes are likely to affect the individual.

Importance of Multiple Pneumococcal Vaccines and Future Directions
By developing new adult pneumococcal vaccines with broader serotype coverage, we hope to better protect adults against IPD. With the availability of multiple adult pneumococcal vaccines, healthcare professionals’ recommendations to patients can take into account geographic variations in serotypes, serotypes responsible for pneumococcal diseases in specific populations, and vaccine availability.

It is important to increase vaccination coverage among adults who may benefit, and we must seize every opportunity to vaccinate our patients.

Other pneumococcal vaccines with broader serotype coverage are in the early stages of clinical development and may be available in the future. Continued evolution of the serotypes responsible for pneumococcal disease means that the need to develop new vaccines to cover additional serotypes will continue.

Your Thoughts?
Which new or emerging pneumococcal vaccine are you most interested in using to vaccinate your adult patients? Join the conversation by leaving a comment.