#2-45E. The New Frontier: ACIP Recommendations for PCV21 in US Adults (MMWR, 2024)

As clinicians, how do we optimize pneumococcal conjugate vaccine (PCV) selection for high-risk adults and older patients, ensuring the broadest possible serotype coverage against Invasive Pneumococcal Disease (IPD)? This report summarizes the rationale and evidence considered by the Advisory Committee on Immunization Practices (ACIP) regarding the use of the newly FDA-approved 21-valent PCV (PCV21; CAPVAXIVE) for adults aged 18 years and older. PCV21 is notable because it incorporates eight serotypes not present in previously licensed vaccines, aiming to enhance protection. The most significant clinical update is the ACIP recommendation for a single dose of PCV21 as an added option for all adults currently recommended to receive a PCV (i.e., those aged ≥65 years and high-risk adults aged 19–64 years). This addition is expected to prevent substantial disease caused by these unique serotypes, which have been significant contributors to IPD cases in this population. However, a key consideration for critical appraisal is that PCV21 does not include serotype 4, which is a relevant pathogen in certain populations and geographic areas (e.g., the Western U.S.). These new guidelines are crucial for clinicians navigating the expanded vaccine landscape, enabling them to tailor the optimal pneumococcal prevention strategy based on individual patient risk factors and the local epidemiology of pneumococcal disease.

Citation: Kobayashi M, Leidner AJ, Gierke R, et al. Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73(36):793–798. DOI: http://dx.doi.org/10.15585/mmwr.mm7336a3

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