RG, a 53-year-old female, presents to your community pharmacy and tells you her physician recommended she receive a pneumococcal vaccine. She has not had any previous pneumococcal vaccines.  

Past medical history:

Osteoporosis: Fosamax 70mg orally once weekly

Hypothyroidism: Levothyroxine 88mcg orally QAM

Allergies: Sulfa, Eggs

Which of the following would you recommend to RG? Select all that apply.

A. Receive one dose of Vaxneuvance

B. Receive one dose of Prevnar20

C. Receive one dose of Capvaxive

D. Receive one dose of Prevnar20, followed by one dose of Capvaxive eight weeks later

E. Receive one dose of Vaxneuvance, followed by one dose of Pneumovax23 one year later

F. RG is ineligible for any pneumococcal vaccines due to her egg allergy

Answer with rationale:

Streptococcus pneumoniae is a gram-positive bacteria that can cause a range of infections, including pneumonia, meningitis, and bloodstream infections, particularly in young children, the elderly, and those with weakened immune systems. The pneumococcal vaccine helps protect against these infections by stimulating the immune system to recognize and fight the bacteria with either sugars attached to a protein carrier (PCV), or just sugars (PPSV). There are four currently recommended pneumococcal vaccines for adults, with the numbers after each name representing the amount of serotypes the vaccine protects against: PCV15 (Vaxneuvance), PCV20 (Prevnar20), PCV21 (Capvaxive), and PPSV23 (Pneumovax23). The CDC vaccination schedule for pneumococcal vaccines in adults >50 years old was updated in October 2024, and added recommendations specific to immunocompromised patients. Vaccination has significantly reduced the incidence of severe pneumococcal diseases, preventing complications and hospitalizations.

Answer A is incorrect: Vaxneuvance is a 15-valent PCV that is generally used in two different scenarios. 1) as a four-dose series from ages 2 months to 15 months, and 2) as the first part of a series with Pneumovax23 in adults greater than 50 years old.

Answer B is correct: Prevnar20 is a 20-valent PCV that is also used in young children on the same four dose schedule as Vaxneuvance. It is also used in adults older than 50, however it is considered a “one-and-done” vaccine, and once received, the patient has fully completed their pneumococcal vaccine schedule.

Answer C is correct: Capvaxive is a 21-valent PCV, however it is important to note that it is a different set of serotypes, not just one more than the Prevnar20. It is only used as a “one-and-done” vaccine. 

Answer D is incorrect: One dose of either the Prevar20 or the Capvaxive is sufficient for a non-immunocompromised adult over 50 years old.

Answer E is correct: As mentioned in the rationale for Answer A, an initial dose of Vaxneuvance followed by the Pneumovax23 is a preferred option for adults over 50 years old. These are generally separated by at least one year, but if a patient has certain immunocompromising factors, such as CKD, HIV, asplenia, or any patient with a cochlear implant, they can be administered as early as 8 weeks apart.

Answer F is incorrect: While egg proteins are used in some influenza and yellow fever vaccines, pneumococcal vaccines are not produced with any egg product.  

Current CDC recommendations on pneumococcal vaccination can be found here: https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html. 

Brand/generics Covered:

Alendronate (Fosamax), Levothyroxine (Synthroid, Levothroid, Tirosint), PCV15 (Vaxneuvance), PCV20 (Prevnar20), PCV21 (Capvaxive), PPSV23 (Pneumovax23)

Naplex Content Domains Covered

2.C.1 - Vaccine indications and Scheduling

3.C.2 - Appropriateness of Therapy