Comparison of Pneumococcal Vaccines

Full update May 2023

The chart below compares the available pneumococcal vaccines including vaccine type, serotypes covered, dosing, immunity, and cost.  For guidance on which adult should get which pneumococcal vaccine see:  https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf (US) or https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-16-pneumococcal-vaccine.html#a6 (Canada).

--Information in the chart below is from the product labeling (footnote a), unless otherwise indicated--

Vaccine

Pneumovax 23 (PPSV23)

Prevnar 13 (PCV13)

Vaxneuvance (PCV15)

Prevnar 20 (PCV20)

Type of vaccinea

polysaccharide

conjugateb

conjugateb

conjugateb

Additional serotypes coveredc

2, 8, 9N, 10A, 11A, 12F, 15B,17F, 20, 22F, 33F

6A

6A, 22F, 33F

6A, 8, 10A, 11A, 12F, 15B, 22F, 33F

Approved age and dose
  • ≥50 years old
  • ≥2 years old at increased risk for pneumococcal diseased
  • single 0.5 mL dose  (IM or subcutaneous)
  • 6 weeks to 5 years old:    
  • 4-dose series (each dose 0.5 mL IM)
  • ≥6 years old:  
  • single 0.5 mL IM dose

 
  • US:  4-dose series, starting at 6 to 8 weeks (each dose 0.5 mL IM)
  • Canada:  3- or 4-dose series, starting at 6 to  12 weeks old (each dose 0.5 mL IM)
  • ≥18 years old
    • single 0.5 mL IM dose
  • ≥18 years oldf
    • single 0.5 mL IM dose

 

Comments
  • ~8% to 15% of invasive disease (depending on age) is caused by serotypes only covered by this vaccine.3
  • Routine vaccination workhorse for kids.
  • Recommended in adults with certain conditions.
  • Only covers ~30% of serotypes causing invasive disease.3
  • Covers additional serotypes causing ~15% of invasive disease NOT covered by PCV13 in patients ≥19 years old.3
  • Does NOT provide additional coverage compared to PCV20.
  • Covers additional serotypes causing ~30% of invasive disease NOT covered by PCV13 in patients ≥19 years old.3

 

Immunity
  • Models project linear decline over 15 years.3
  • Models project no decline for 5 years, followed by linear decline over 10 years.3
  • Evidence suggests these may have a greater immune response than PPSV23 against most serotypes they have in common.3-5

Cost per dosee

US:  ~$120

Canada:  ~$35

US:  ~$230

Canada:    ~$110

US:  ~$220

Canada:    ~$110

US:  ~$255

Canada:    ~$120
  1. US product labeling:  Pneumovax 23 (April 2021); Prevnar 13 (July 2019); Vaxneuvance (June 2022); Prevnar 20 (June 2021).   Canadian product labeling:  Pneumovax 23 (April 2016); Prevnar 13 (August 2019); Vaxneuvance (June 2022); Prevnar 20 (May 2022).  
  2. The act of conjugating or linking the polysaccharide vaccine to a carrier protein enhances immunogenicity.1
  3. All available pneumococcal vaccines contain the following serotypes:  1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F.a
  4. Examples of conditions that may increase the risk for pneumococcal disease include:  anatomic or functional asplenia, sickle cell disease, human immunodeficiency virus infection, chronic heart or lung disease, cerebrospinal fluid leaks, and diabetes mellitus.2
  5. Pricing is based on wholesale acquisition cost (WAC).  US medication pricing by Elsevier, accessed April 2023.
  6. US approval for use in children anticipated in 2023 (PCV20).3

 References

  1. CDC.  Principles of vaccination.  In:  Epidemiology and prevention of vaccine-preventable diseases.  The Pink Book:  Course Textbook. 14th Ed. 2021.  https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/prinvac.pdf.  (Accessed April 24, 2023).
  2. Nuorti JP, Whitney CG; Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 Dec 10;59(RR-11):1-18.
  3. CDC.  Considerations for age-based and risk-based use of PCV15 and PCV20 among U.S. adults and proposed policy options.  October 20, 2021.  https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-10-20-21/02-Pneumococcal-Kobayashi-508.pdf.  (Accessed April 24, 2023).
  4. Hurley D, Griffin C, Young M, et al. Safety, Tolerability, and Immunogenicity of a 20-Valent Pneumococcal Conjugate Vaccine (PCV20) in Adults 60 to 64 Years of Age. Clin Infect Dis. 2021 Oct 5;73(7):e1489-e1497.
  5. Song JY, Chang CJ, Andrews C, et al. Safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, followed by sequential PPSV23 vaccination in healthy adults aged ≥50 years: A randomized phase III trial (PNEU-PATH). Vaccine. 2021 Oct 15;39(43):6422-6436.

 Cite this document as follows:  Clinical Resource, Comparison of Pneumococcal Vaccines.  Pharmacist’s Letter/Prescriber’s Letter.  May 2023. [390515]


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