Know What’s New With Pneumococcal Immunization Guidelines

You’ll need to know who should get one of the new pneumococcal vaccines, Prevnar 20 or 15-valent Vaxneuvance...and when.

These conjugate vaccines may lead to longer-lasting and better immunity than Pneumovax 23 polysaccharide vaccine.

This is leading to changes in pneumococcal guidelines.

For adults, give one dose of Prevnar 20 in most cases, depending on risk factors and vaccine history...or Vaxneuvance PLUS Pneumovax 23 as an alternative. After that, no boosters are needed.

Explain that Pneumovax 23 is given in addition to Vaxneuvance to broaden coverage. About 15% of invasive pneumococcal disease is caused by the 5 serotypes in Prevnar 20 that aren’t in Vaxneuvance.

Use the table below to help keep it all straight.

Patient Vaccine History Recommended Alternative
18 to 64 years with an immunocompromising condition No prior vaccine or vaccination status unknown One dose of Prevnar 20 Vaxneuvance followed by Pneumovax 23,
separated by 8 weeks
50 to 64 years with risk factors (diabetes, etc)  No prior vaccine or vaccination status unknown One dose of Prevnar 20 Vaxneuvance followed by Pneumovax 23,
separated by 1 year
65 years and older No prior vaccine or vaccination status unknown
Pneumovax 23 at least 5 years prior
Prevnar 13 and Pneumovax 23 series at least 5 years prior
Prevnar 13 at least 1 year prior

Expect Prevnar 20 to cost about $120/dose and Vaxneuvance plus Pneumovax 23 about $140...but these will likely be funded provincially.

For kids and adolescents, give either Prevnar 13 or Vaxneuvance...whichever you have in stock. It’s okay to interchange these...even partway through a primary series.

Use the opportunity to give other vaccines (COVID-19, etc) with a pneumococcal vaccine if needed.

Check out our resource, Comparison of Pneumococcal Vaccines, to compare serotypes covered, immunity, and more.


Key References

  • https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/public-health-level-recommendations-use-pneumococcal-vaccines-adults-including-use-15-valent-20-valent-conjugate-vaccines/recommendations-use-pneumococcal-vaccines-adults-15-20-valent-conjugate.pdf (5-1-23)
  • https://www.canada.ca/content/dam/hc-sc/documents/services/publications/vaccines-immunization/national-advisory-committee-immunization-interim-guidance-pneumococcal-15-valent-conjugate-vaccine-pneu-c-15-pediatric-populations/national-advisory-committee-immunization-interim-guidance-pneumococcal-15-valent-conjugate-vaccine-pneu-c-15-pediatric-populations.pdf (5-1-23)
  • https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2023-49/issue-2-3-february-march-2023/naci-statement-public-health-reccomendations-pneumococcal-vaccines.html (5-1-23)
Pharmacist's Letter Canada. May 2023, No. 390515



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