Prevnar 20 (Pneumococcal 20-valent Conjugate Vaccine)

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Recommendations

Now recommended by NACI

NACI recommends the pneumococcal conjugate vaccine PREVNAR 20 to:¹

Patients aged	Who are	Strength of recommendation
≥65	Pneumococcal vaccine-naïve or with unknown vaccination status *Previously vaccinated with a pneumococcal vaccine (≥5 years from the last dose of PNEU-P-23)**	Strong
50-64	Living with risk factors that place them at higher risk of pneumococcal disease	Strong
18-49	Living with immunocompromising conditions or who received a hematopoietic stem cell transplant after consultation with transplant specialist	Strong

As per the Product Monograph, PREVNAR 20 can be given ≥6 months after PNEU-C-13 dose and ≥1 year after PNEU-C-13/PNEU-P-23 doses in adults ≥65 years.^2†

NACI: National Advisory Committee on Immunization.

For those previously vaccinated with PREVNAR 13 alone or followed by PREVNAR 23, please consult the NACI recommendations.

What are the recommendations for adults 18–49 years old with
non-immunocompromising risk factors?

At this time there are no public health level recommendations on the use of PREVNAR 20 for adults 18–49 years old with non-immunocompromising risk factors that place them at high risk of IPD as additional analyses on the cost-effectiveness of PREVNAR 20 in this population are needed. PREVNAR 20 may be considered at clinical discretion for this population.¹

Consider offering PREVNAR 20 to your adult patients, as per NACI’s recommendation.

Visit the NACI website for the most current statements on pneumococcal vaccines.

Conditions placing patients at increased risk of pneumococcal disease^1,3

Medical conditions	Environmental or living conditions for individuals
Congenital immunodeficiencies involving any part of the immune system, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity, complement system (properdin, or factor D deficiencies), or phagocytic functions Immunocompromising therapy, including use of long-term corticosteroids, chemotherapy, radiation therapy, and post-organ transplant therapy HIV infection Hematopoietic stem cell transplant (HSCT) (recipient) Malignant neoplasms, including leukemia and lymphoma Solid organ or islet transplant (recipient) Chronic kidney disease, particularly those with nephrotic syndrome, on dialysis or with renal transplant* Chronic liver disease, including biliary atresia and hepatic cirrhosis due to any cause† Functional or anatomic asplenia, including sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, or splenic dysfunction Chronic cerebrospinal fluid (CSF) leak Cochlear implants, including those who are to receive implants^‡ Chronic neurologic conditions that may impair clearance of oral secretions^§ Chronic heart disease, including congenital heart disease and cyanotic heart disease^§ Diabetes mellitus^§ Chronic lung disease, including asthma requiring medical care in the preceding 12 months^§	Who are underhoused or experiencing homelessness Who live in communities or settings experiencing sustained high IPD rates Who smoke^§ With substance use disorders (i.e., cocaine use and injection drug use)^§ With alcohol use disorder^§ Who are in residential care, including long-term care homes and residential care homes for children with complex medical needs

Medical conditions

Environmental or living conditions for individuals

Congenital immunodeficiencies involving any part of the immune system, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity, complement system (properdin, or factor D deficiencies), or phagocytic functions
Immunocompromising therapy, including use of long-term corticosteroids, chemotherapy, radiation therapy, and post-organ transplant therapy
HIV infection
Hematopoietic stem cell transplant (HSCT) (recipient)
Malignant neoplasms, including leukemia and lymphoma
Solid organ or islet transplant (recipient)
Chronic kidney disease, particularly those with nephrotic syndrome, on dialysis or with renal transplant*
Chronic liver disease, including biliary atresia and hepatic cirrhosis due to any cause†
Functional or anatomic asplenia, including sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, or splenic dysfunction
Chronic cerebrospinal fluid (CSF) leak
Cochlear implants, including those who are to receive implants^‡
Chronic neurologic conditions that may impair clearance of oral secretions^§
Chronic heart disease, including congenital heart disease and cyanotic heart disease^§
Diabetes mellitus^§
Chronic lung disease, including asthma requiring medical care in the preceding 12 months^§

Who are underhoused or experiencing homelessness
Who live in communities or settings experiencing sustained high IPD rates
Who smoke^§
With substance use disorders (i.e., cocaine use and injection drug use)^§
With alcohol use disorder^§
Who are in residential care, including long-term care homes and residential care homes for children with complex medical needs

Individuals with nephrotic syndrome, end-stage renal disease, rapid progression towards dialysis or on dialysis are at highest risk and should be prioritized for vaccination.

Individuals with end-stage liver disease and hepatic cirrhosis are likely highest risk and should be prioritized for vaccination.

The highest risk is in the weeks following surgery. While it is best to administer the vaccine prior to implant, surgery should not be delayed. The vaccine should be given as soon as possible.

Immunization only recommended for children and adults 50 years of age and older. For adults 18 to 49 years of age, pneumococcal vaccination with PREVNAR-15 or PREVNAR-20 may be considered at clinical discretion.

PREVNAR 20 is indicated for active immunization for the prevention of pneumonia and invasive pneumococcal disease (including sepsis, meningitis, bacteremic pneumonia, pleural empyema and bacteremia) in adults caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F.²

Relevant warnings and precautions:

Immunocompromised individuals may have a reduced antibody response to the vaccine.²
Safety and immunogenicity data on PREVNAR 20 are not available for individuals in certain immunocompromised groups (e.g., those with malignancy or nephrotic syndrome) and vaccination should be considered on an individual basis. Some safety and immunogenicity data are available in individuals with sickle cell disease, HIV infection, or hematopoietic stem cell transplant.²
The administration of PREVNAR 20 should be postponed in individuals with acute severe febrile illness.²
As with any intramuscular injection, PREVNAR 20 should be given with caution in individuals with thrombocytopenia or any coagulation disorder, or receiving anticoagulant therapy.²
May not protect all individuals from pneumococcal disease.²

For more information:

Please consult the Product Monograph for important information relating to adverse reactions, drug interactions, and dosing information, which have not been discussed in this piece. The Product Monograph is also available on request by calling 1-800-463-6001.

References:

An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) Public health level recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines. February 2023. Accessed on June 17, 2024.

PREVNAR 20 Product Monograph. Pfizer Canada ULC.November 16, 2023.

Government of Canada. Pneumococcal Vaccines: Canadian Immunization Guide. For healthcare professionals. Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-16-pneumococcal-vaccine.html. Accessed on October 4, 2024.

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