Pneumococcal Vaccines Work Group Considera

Next StepsMiwako Kobayashi, MD, MPHPneumococcal Vaccines Work GroupAdvisory Committee on Immunization PracticesFebruary 22, 2023
Proposed Policy Questions

 Should PCV20 be recommended as an option for pneumo

conjugate vaccination according to currently recommendeschedules, for U.S. children aged <2 years?

 Should PCV20 without PPSV23 be recommended as an op

pneumococcal vaccination for U.S. children aged 2–18 yeaunderlying medical conditions that increase the risk of pndisease?
Additional Considerations

 Cost-effectiveness analysis will be performed to assess:

• Incremental benefit of PPSV23 use in addition to PCV20 

aged 2–18 years with underlying medical conditions.

• Incremental benefit of PCV20 use in children who comp

recommended PCV series with either PCV13 or PCV15.
Pneumococcal Disease Risk in Children with Underlying 

Conditions

Asthma, Chronic Kidney Disease, Chronic Liver Disease
Specific Questions Being Considered by the W

Group• Are children with asthma at increased risk of pneumococcal d

regardless of high-dose oral corticosteroid use? 

• Are children with chronic liver disease at increased risk of p

disease?

• Are children with chronic kidney disease of any stage at inc

of pneumococcal disease?
Differences in the Indications for Children vs 

with Asthma

• Pediatric recommendation1,2

:

• Including asthma if treated with high-dose oral 

corticosteroid therapy

• Adult recommendation3,4

:

• Includes chronic obstructive pulmonary disease, 

emphysema, and asthma

1. Nuorti et al. MMWR RR 2010

2. Kobayashi et al. MMWR 2022. 71(37); 1174–1181 3. Matanock et al. MMWR 20194. Kobayashi et al. MMWR 2022. 71(4); 109–117 
Risk-Based Pneumococcal Vaccine Recomme

Children Adults

AlcoholismChronic heart diseaseChronic lung diseaseChronic liver diseaseCigarette smokingDiabetes mellitusCerebrospinal fluid leakCochlear implantChronic renal failure or nephrotic syndromeCongenital or acquired asplenia, or splenic dysfunctionCongenital or acquired immunodeficiencyDiseases and conditions treated with immunosuppressive drugs or radiation therapyHIV infectionSickle cell disease or other hemoglobinopathiesSolid organ transplant

Should we add “chronic liver disease” as parrisk-based recommendation? 
Risk-Based Pneumococcal Vaccine Recomme

Children Adults

AlcoholismChronic heart diseaseChronic lung diseaseChronic liver diseaseCigarette smokingDiabetes mellitusCerebrospinal fluid leakCochlear implant

Chronic renal failure or nephrotic syndrome

Congenital or acquired asplenia, or splenic dysfunctionCongenital or acquired immunodeficiencyDiseases and conditions treated with immunosuppressive drugs or radiation therapyHIV infectionSickle cell disease or other hemoglobinopathiesSolid organ transplant

The intent has been to provide additional prthose on dialysis or about to be on dialysis Should the risk-based recommendations all CKD stages? 
Work Group Next Steps
Work Group Next Steps

• Review of evidence and Work Group interpretation of remaining Et

(Values, Acceptability, Resource Use, Feasibility)

• Review findings from cost-effectiveness analyses (CDC and other gr

• Draft policy options on PCV20 use in U.S. children for consideration 

committee
Questions for the Committee

• Does the Committee agree with the policy questions bei

considered by the Work Group?

• Are there additional data the Committee would like to se

deciding on policy options for a vote? 
For more information, contact CDC

1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.