The Advisory Committee on Immunization Practice (ACIP) has recommended pneumococcal 21-valent conjugate vaccine (PCV21) as an option for adults aged 19 years or older who currently have a recommendation to receive a dose of PCV.

The recommendation became official when it was adopted in late June by the CDC director.

The ACIP panel unanimously voted to recommend Capvaxive (PCV21) as an option for adults aged 65 years and older for pneumococcal vaccination.

Recommended for a single dose of PCV21 are:

• Adults aged 65 years and older who have not previously received a PCV or whose previous vaccination history is unknown
• Adults aged 19 to 64 years with certain underlying medical conditions or other risk factors who have not previously received a PCV or whose previous vaccination history is unknown
• Adults aged 19 years and older who have started their pneumococcal vaccine series with PCV13 (pneumococcal 13-valent conjugate vaccine) but have not received all recommended PPSV23 (pneumococcal 23-valent polysaccharide vaccine) doses.

The CDC also recommends shared clinical decision-making regarding use of a supplemental dose of PCV21 for adults aged 65 years and older who have completed their vaccine series with both PCV13 and PPSV23.

Merck announced on June 17 that the FDA had approved Capvaxive for active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B in individuals aged 18 years and older, as well as active immunization for the prevention of pneumonia caused by S pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B in individuals aged 18 years and older.

The approval was based on priority review. The vaccine should not be administered to anyone with a history of several allergic reaction to any component of the vaccine or to diphtheria toxoid, according to the FDA.

The serotypes covered by the vaccine are responsible for more cases of invasive pneumococcal disease (IPD) in adults compared with PCV20 (pneumococcal 20-valent conjugate vaccine) based on CDC data not a clinical study.

Specifically, according to a Merck press release, in adults aged 50 years and older, Capvaxive covers the serotypes responsible for approximately 84% of IPD cases, compared with approximately 52% covered by PCV20. In adults aged 65 years and older, the vaccine covers the serotypes responsible for approximately 85% of IPD cases, compared with approximately 51% covered by PCV20.

In terms of other adult vaccines recommended at the June 26-28 meeting and which the CDC director accepted, ACIP urged that anyone aged older than 6 months receive the 2024-2025 COVID-19 vaccines as authorized or approved by the FDA. It also reaffirmed the recommendation for routine annual influenza vaccination of anyone aged 6 months or older who do not have contraindications.

High-dose inactivated (HD-IIV3) and adjuvanted inactivated (aIIV3) influenza vaccines were endorsed as acceptable options for influenza vaccination of solid organ transplant recipients aged 18 through 64 years who are on immunosuppressive medication regimens, without a preference over other age-appropriate IIV3s or RIV3.

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