Recent Developments and Future Directions of Pneumococcal Vaccine Recommendations

Purpose: The goal of this article was to review the key clinical trials that resulted in the recent recommendation from the Advisory Committee on Immunization Practices (ACIP) to vaccinate all adults aged >= 65 years with the 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) in addition to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). Methods: Pertinent articles were identified through searches of EMBASE and MEDLINE by using the terms pneumococcal polysaccharide conjugate vaccine, pneumococcal vaccine, and PCV13. Searches were limited to articles published between January 1, 2013, and January 31, 2015, and were limited to clinical trials. Resources from the Centers for Disease Control and Prevention's ACIP recommendations and cited references were also reviewed. Findings: Recent clinical trials have focused on the order of administration of PPSV23 and PCV13, comparisons in immunogenicity of PPSV23 and PCV13, and efficacy of PCV13 in adults aged >= 65 years. Immunogenicity trials have shown that PCV13 elicits an equal or greater immune response than PPSV23 for most of the serotypes that both vaccines share. The evidence suggests that PCV13 should be administered before PPSV23 when possible. Most recently, clinical data demonstrated the efficacy of PCV13 in adults aged >= 65 years. Implications: Recent randomized clinical trials and disease trends have prompted the ACIP to recommend that all adults aged >= 65 years receive a single dose of PCV13. This is in addition to the previous recommended single dose of PPSV23 in the same population. The ACIP and the Centers for Disease Control and Prevention plan to monitor disease trends and clinical data to determine if this recommendation will need to be changed in the future. (C) 2015 Elsevier HS Journals, Inc. All rights reserved.