Pneumococcal Vaccines

Katherine A. Poehling, MD, MPH

Pneumococcal Vaccines Work Group Chair

Advisory Committee on Immunization Practices

June 22, 2023
Pneumococcal Vaccines Work Group

ACIP Members

• Katherine Poehling (Chair)

• Sarah Long 

Ex Officio Members

• Jeffrey Kelman (CMS)

• Lucia Lee (FDA)

• Tina Mongeau (FDA)

• Uzo Chukwuma (IHS)

• Mamodikoe Makhene (NIH)

CDC Lead

• Miwako Kobayashi (NCIRD)

Liaison Representatives and Consultants

• Lynn Fisher (AAFP)

• Mark Sawyer (AAP/COID)

• Jason Goldman (ACP)

• David Nace (AGS/AMDA)

• Cora Hoover (AIM)

• Aleksandra Wierzbowski (NACI)

• James McAuley (IDSA)

• William Schaffner (NFID)

• Virginia Caine (NMA)

• Monica Farley (VAMC/Emory)

• Keith Klugman (BMGF)

• Arthur Reingold (UC Berkley)

• Lorry Rubin (CCMC)

• Richard Zimmerman (U. of Pittsburgh) 
Pneumococcal Vaccines Work Group

CDC Contributors

• Adam Cohen (Respiratory Diseases Branch)

• Ryan Gierke (Respiratory Diseases Branch)

• Jennifer Farrar (Respiratory Diseases Branch)

• Diepreye Ayabina (Division of Bacterial Diseases)

• Pedro Moro (Immunization Safety Office)

• Andrew Leidner (Immunization Services Division)

• Liz Velazquez (Immunization Services Division)

• Marc Fischer (Arctic Investigations Program)

• Noele Nelson (Division of Bacterial Diseases)

GRADE/EtR consultants

• Doug Campos-Outcalt

• Rebecca Morgan
Serotypes contained in pneumococcal vaccines

Pneumococcal conjugate vaccines (PCVs): PCV13, PCV15, PCV20

Pneumococcal polysaccharide vaccine (PPSV): PPSV23

• PCV15 non-PCV13: serotypes 22F and 33F

• PCV20 non-PCV15: serotypes 8, 10A, 11A, 12F, and 15B

• PPSV23 non-PCV20: serotypes 2, 9N, 17F, and 20

1 3 4 5 6A 6B 7 F 9V 14 18

C

19

A

19

F

23

F

22

F

33

F

8 10

A

11

A

12

F

15

B

2 9N 17

F

20

PCV13

PCV15

PCV20

PPSV23

4
Extended indication for PCV20 use among children approved on 

April 27, 2023

2021 2022 2023

Pediatric PCV20 use approved 

April 2023

Pediatric PCV15 use approved

June 2022

PCV15 and PCV20 approved

for use in adults in 2021
Both PCV15 and PCV20 were approved based on safety and 

immunogenicity data compared with PCV13

• No direct PCV15 vs PCV20 comparison

• Unknown clinical implications:

• Numerically lower antibody responses vs PCV13

• Numerically higher antibody response against serotype 3 in PCV15 vs PCV13

February 2022, 2023 ACIP meeting presentations
All children under age 2 years have the same 

pneumococcal vaccine recommendations

• 3 primary series and a booster=“3+1” schedule

PCV PCV PCV PCV

2 months 4 months 6 months 12–15 months

Primary Series Booster

Currently, either PCV13 or PCV15 can be used
Children with certain underlying conditions are recommended 

to receive PPSV23 in addition to the recommended PCV doses

Use of 15-Valent Pneumococcal Conjugate Vaccine Among U.S. Children: Updated Recommendations of the Advisory Committee on Immunization 

Practices — United States, 2022 | MMWR (cdc.gov)

PPSV23

≥8 weeks

Recommended 

PCV doses PPSV23 PPSV23

≥8 weeks ≥5 years

PPSV23

Recommended 

PCV doses

Note: Excludes catch-up vaccination schedules.

CMC=chronic medical conditions, including chronic heart disease, chronic lung disease, diabetes mellitus

CSF=cerebrospinal fluid 

Recommended 

PCV doses

Healthy 

children

CMC, CSF leak, 

cochlear 

implant

Immunocompromised

CMC aged 6–18 

years 
Current Risk-Based Pneumococcal Vaccine Recommendations

Children Adults

Alcoholism

Chronic heart disease

Chronic lung disease

Chronic liver disease

Cigarette smoking

Diabetes mellitus

Cerebrospinal fluid leak

Cochlear implant

Chronic renal failure or nephrotic syndrome

Congenital or acquired asplenia, or splenic 

dysfunction

Congenital or acquired immunodeficiency

Diseases and conditions treated with 

immunosuppressive drugs or radiation therapy

HIV infection

Sickle cell disease or other hemoglobinopathies

Solid organ transplant

• Children: Including asthma if treated with high-dose oral 

corticosteroid therapy.

• Adults: Includes chronic obstructive pulmonary disease, 

emphysema, and asthma.

→ Should we expand the indication for asthma in children? 
Current Risk-Based Pneumococcal Vaccine Recommendations

Children Adults

Alcoholism

Chronic heart disease

Chronic lung disease

Chronic liver disease

Cigarette smoking

Diabetes mellitus

Cerebrospinal fluid leak

Cochlear implant

Chronic renal failure or nephrotic syndrome

Congenital or acquired asplenia, or splenic 

dysfunction

Congenital or acquired immunodeficiency

Diseases and conditions treated with 

immunosuppressive drugs or radiation therapy

HIV infection

Sickle cell disease or other hemoglobinopathies

Solid organ transplant

Should we add “chronic liver disease” as part of pediatric 

risk-based recommendation? 
Current Risk-Based Pneumococcal Vaccine Recommendations

Children Adults

Alcoholism

Chronic heart disease

Chronic lung disease

Chronic liver disease

Cigarette smoking

Diabetes mellitus

Cerebrospinal fluid leak

Cochlear implant

Chronic renal failure or nephrotic 

syndrome

Congenital or acquired asplenia, or splenic 

dysfunction

Congenital or acquired immunodeficiency

Diseases and conditions treated with 

immunosuppressive drugs or radiation therapy

HIV infection

Sickle cell disease or other hemoglobinopathies

Solid organ transplant

Should we expand the indication to those with stage 2–5 

chronic kidney disease? 
Policy questions considered by the Work Group

• Should PCV20 be recommended as an option for pneumococcal 

conjugate vaccination according to currently recommended dosing 

and schedules, for U.S. children aged <2 years?

• Should PCV20 without PPSV23 be recommended as an option for 

pneumococcal vaccination for U.S. children aged 2–18 years with 

underlying medical conditions that increase the risk of 

pneumococcal disease?
Today’s Pneumococcal Vaccines session outline

Introduction Dr. Katherine Poehling 

(ACIP, WG Chair)

Economic analysis and public health impact of PCV20 

use in children

Dr. Charles Stoecker 

(Tulane University)

Comparison of cost-effectiveness analyses on PCV20 

use in children

Dr. Ayabina Diepreye 

(CDC/NCIRD)

Summary of WG interpretation of EtR and policy 

options

Dr. Miwako Kobayashi 

(CDC/NCIRD)

VFC resolution Dr. Jeanne Santoli

(CDC/NCIRD)