Summary of National Advisory Committee on Immunization (NACI) Statement of February 2023: Public Health Level Recommendations on the Use of Pneumococcal Vaccines in Adults, Including the Use of 15-Valent and 20-Valent Conjugate Vaccines

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• Overview
• What you need to know

Overview

• Health Canada has authorized two new pneumococcal vaccines for adults 18 years of age and older, Prevnar^®20 (PNEU-C-20) on May 9, 2022, and Vaxneuvance^® (PNEU-C-15) on November 16, 2021. Vaxneuvance^® has also been authorized for infants and children from 6 months to 17 years of age on July 8, 2022.
• On February 24, 2023, the Public Health Agency of Canada (PHAC) released updated public health level recommendations from the National Advisory Committee on Immunization (NACI) on the use of pneumococcal vaccines in adults. This guidance is based on current evidence and NACI expert opinion.
• Pneumococcal infections can range from ear and sinus infections, to pneumonia, to more serious infections called invasive pneumococcal disease (IPD).
• The most effective way to prevent pneumococcal infections is through immunization. For decades, adults especially those over 65 years of age have been recommended to receive Pneumovax^®23 (PNEU-P-23). More recently, adults living with certain medical and other conditions that put them at highest risk of pneumococcal infections and their complications were recommended to receive Prevnar^®3 (PNEU-C-13) as well as Pneumovax^®23

After reviewing the safety and immune responses provided by Prevnar^®20 and Vaxneuvance^® in adults, NACI has made the following recommendations for public health level decision-making:

• For adults who have not been previously vaccinated with a pneumococcal vaccine, NACI recommends that a single dose of Prevnar^®20 should be offered to:
  • Adults 65 years of age and over
  • Adults 50 to 64 years of age living with factors that place them at higher risk of pneumococcal disease
  • Adults 18 to 49 years of age with immunocompromising conditions
• As a discretionary recommendation, NACI recommends:
  • A single dose of Vaxneuvance^® followed by a single dose of Pneumovax^®23 may be offered as an alternative to Prevnar^®20
  • For adults 18-49 years of age with non-immunocompromising risk factors, Prevnar^®20 and Vaxneuvance^® may be considered at clinical discretion.
• For adults who have previously received a pneumococcal vaccine, NACI recommends that a single dose of Prevnar^®20:
  • Should be offered to adults 65 years of age and over who have received Pneumovax^®23 alone or both Prevnar^®13 and Pneumovax^®23, if it has been at least 5 years since the last dose of a pneumococcal vaccine.
• As a discretionary recommendation, NACI recommends that a single dose of Prevnar^®20:
  • May be offered to adults 65 years of age and over who have received Prevnar^®13 alone, if it has been 1 year since the last dose of Prevnar^®13
  • For adults who have received a hematopoietic stem cell transplant (HSCT), see the full statement (linked below) for additional recommendations.

What you need to know

• Pneumococcal disease is the name for any infection caused by the Streptococcus pneumoniae bacteria. Pneumococcal infections can range from ear and sinus infections, to pneumonia, to more serious conditions called invasive pneumococcal disease (IPD). IPD is a severe form of infection that occurs when the bacteria enters the bloodstream (called sepsis) or the central nervous system (called meningitis).
• IPD is common in older adults and adults with underlying medical conditions or certain lifestyle risk factors. For more information on medical conditions and lifestyle factors that increase the risk of IPD, please see the Pneumococcal vaccine chapter of the Canadian Immunization Guide (CIG).
• Available evidence suggests that Prevnar^®20 and Vaxneuvance^® have comparable safety profiles to other pneumococcal vaccines currently used for adults in Canada.
• Prevnar^®20 and Vaxneuvance^® (as well as Prevnar^®13) are known as pneumococcal conjugate vaccines. They trigger the immune system in a different way than Pneumovax^®23, which is known as a polysaccharide vaccine. Conjugate vaccines offer more durable and longer lasting protection than polysaccharide vaccines.
• There are many serotypes of the S. pneumoniae bacteria. NACI is recommending the use of Prevnar^®20 in older adults and those at highest risk of IPD because it can protect adults against most of the serotypes of the bacteria contained in Pneumovax^®23, with the added benefit of a conjugate vaccine.
• If Prevnar^®20 is not available, NACI recommends that Vaxneuvance^®, which protects against fewer serotypes of bacteria, may be offered as an alternative to Prevnar^®20 as long as Pneumovax^®23 is also provided shortly after to ensure protection against the additional serotypes.
• Pneumococcal vaccines can be administered at the same time as, or any time before or after, other routine vaccines. The different types of pneumococcal vaccine (e.g., Vaxneuvance^® and Pneumovax^®23) should not be provided at the same time. See the full statement for the recommended intervals between the pneumococcal vaccines.
• Prevnar^®20 is not currently included in publicly funded Provincial and Territorial immunization programs. Provinces and territories will review this latest NACI advice to determine whether to integrate the new products into their funded programs. In the meantime, they will continue to offer the existing pneumococcal vaccines (Pneumovax^®23 and Prevnar^®13) to those who were already recommended to receive them.
• There are several vaccines now authorized in Canada to prevent pneumococcal disease in adults. Please talk to your healthcare provider to determine what vaccine is recommended for you based on your age, vaccine history, and health status.

For the full statement, including supporting evidence and rationale and recommendations for HSCT recipients, please see NACI Statement: Public health level recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines on the NACI webpage.

For more information on NACI recommendations related to pneumococcal vaccines, please see the Canadian Immunization Guide Chapter on Pneumococcal Vaccines.