Updated Canadian recommendations on the use of pneumococcal vaccines in adults

The National Advisory Committee on Immunization (NACI) has issued updated recommendations on the use of pneumococcal vaccines in adults in Canada, including guidance on the use of the new 21-valent pneumococcal conjugate vaccine, Capvaxive.1,2 In February 2023, NACI had issued a statement on the use of two other newer pneumococcal vaccines in public health programs: 15-valent pneumococcal conjugate vaccine (Vaxneuvance) and 20-valent pneumococcal conjugate vaccine (Prevnar 20).3Capvaxive is authorized for use in adults (≥ 18 years of age) for prevention of invasive pneumococcal disease caused by 21 serotypes of Streptococcus pneumoniae (3, 6A/6C, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B/15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F and 35B). Invasive pneumococcal disease is an acute and serious communicable disease with manifestations such as meningitis, bacteremia, and bacteremic pneumonia and empyema. It is most common in the very young, older adults, and groups with medical conditions and/or other risk factors that place them at higher risk.1 Capvaxive contains 10 unique, non-cross-reactive serotypes (9N, 15A, 16F, 17F, 20A, 23A, 23B, 24F, 31 and 35B) that are not present in Prevnar 20, and Prevnar 20 contains nine unique serotypes not included in Capvaxive (1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F).1The updated statement addresses three main questions:1Should Capvaxive be recommended for use in immunization programs for adults currently recommended to receive pneumococcal vaccine, and who have never received pneumococcal vaccination or whose vaccination status is unknown?Should Capvaxive be recommended for use in immunization programs for adults currently recommended to receive pneumococcal vaccine, and who have previously received pneumococcal vaccination?Are there other adults at risk of invasive pneumococcal disease who should be recommended to receive a higher valency pneumococcal vaccination (i.e., Prevnar 20 or Capvaxive)? NACI recommendations for publicly-funded adult immunization programsAdult pneumococcal immunization programs in Canada should include at least one of Prevnar 20 or Capvaxive. (Strong NACI Recommendation)1Post-pandemic changes in circulating pneumococcal serotypes currently make it difficult to determine the relative benefit of Prevnar 20 versus Capvaxive. There may be interjurisdictional variability in serotype circulation. Regional epidemiology should be considered when deciding which vaccine to use, with the selection guided by the largest proportion of serotypes covered in the populations recommended for vaccination.Vaxneuvance should be used only when Prevnar 20 and Capvaxive vaccines are unavailable or inaccessible.12. One dose of either Prevnar 20 or Capvaxive, regardless of pneumococcal vaccination history with Prevnar 13, Vaxneuvance or Pneumovax 23, should be given to: a) Adults 65 years of age and older; and b) Adults under 65 years of age at increased risk of invasive pneumococcal disease (see Table 1 in the NACI statement for a full list of risk factors for invasive pneumococcal disease).1Individuals ≥ 18 years of age who are not included for higher valency pneumococcal vaccine in publicly funded programs may opt to receive higher valency pneumococcal vaccination in consultation with their healthcare provider. Healthcare providers can use the information presented in Table 1 of the NACI statement as a guide when considering individual patient risk(s), and when counselling patients.1 For adults who have previously received pneumococcal vaccination:Based on expert opinion, the recommended interval between Pneumovax 23 and either Prevnar 20 or Capvaxive is now one year; however, an interval as short as eight weeks may be considered in those who might be anticipating initiation of immunosuppressive treatments or who have diseases that might lead to immunodeficiency.When rapid immunization is required (e.g., for immunocompromised individuals), the minimum interval between two different pneumococcal conjugate vaccines is eight weeks.13. Both Prevnar 20 and Capvaxive should be offered to adults ≥ 18 years of age who received a hematopoietic stem cell transplant (HSCT) after consultation with the transplant specialist. (Strong NACI recommendation)1A primary series of three doses starting three to nine months after transplant should be administered, with doses at least four weeks apart, followed by a booster dose 12–18 months post-transplant (6–12 months after the last dose). The recommended timing of pneumococcal vaccination for HSCT recipients should be determined in consultation with the recipient’s transplant specialist.1HSCT recipients will benefit from broader serotype coverage; therefore, the higher valency vaccine that was not given as part of the primary series can be offered as the booster dose at 12–18 months post-transplant (i.e., 3 doses of Prevnar 20 + 1 dose of Capvaxive, or 3 doses of Capvaxive + 1 dose of Prevnar 20).1Other individuals at very high risk of invasive pneumococcal disease could benefit from receiving both Prevnar 20 and Capvaxive. NACI is reviewing these risk groups and will provide recommendations at a later date.1 Dosage, concurrent administration with other vaccinesPrevnar 20 and Capvaxive are supplied in single-dose prefilled syringes. The standard immunization schedule is one 0.5 mL dose, administered intramuscularly. Pneumococcal vaccines may be administered concurrently with other vaccines, with one exception: pneumococcal conjugate and pneumococcal polysaccharide vaccines should not be administered concurrently.1Pneumococcal vaccine comparison chartThe NACI statement includes a table summarizing the properties of pneumococcal vaccines available in Canada (Prevnar 13, Vaxneuvance, Prevnar 20, Capvaxive and Pneumovax 23).1 References1. National Advisory Committee on Immunization (NACI). An Advisory Committee Statement (ACS). Recommendations on the use of pneumococcal vaccines in adults, including PNEU-C-21. November 15, 2024. 2. National Advisory Committee on Immunization (NACI). Summary of NACI statement of November 15, 2024: Recommendations on the use of pneumococcal vaccines in adults, including PNEU-C-21. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-summary-recommendations-use-pneumococcal-vaccines-adults-pneu-c-21.html (accessed December 10, 2024).3. National Advisory Committee on Immunization (NACI). An Advisory CommitteeStatement (ACS). Public health level recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines. February 2023. https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/public-health-level-recommendations-use-pneumococcal-vaccines-adults-including-use-15-valent-20-valent-conjugate-vaccines/recommendations-use-pneumococcal-vaccines-adults-15-20-valent-conjugate.pdf (accessed December 10, 2024).

Updated Canadian recommendations on the use of pneumococcal vaccines in adults

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