Summary of NACI statement of November 15, 2024: Recommendations on the use of pneumococcal vaccines in adults, including PNEU-C-21 

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• Overview
• What you need to know

Overview

• On November 15, 2024, the Public Health Agency of Canada (PHAC) released the National Advisory Committee on Immunization's (NACI) Recommendations on the use of pneumococcal vaccines in adults, including Pneu-C-21. This guidance is based on current evidence and NACI expert opinion.
• Many Canadians that have been eligible for existing pneumococcal immunization programs remain unvaccinated. Pneumococcal vaccination coverage among adults aged 18 and older continues to fall short of the national target goal of 80% by 2025, representing missed opportunities for infection prevention.
• Invasive pneumococcal disease (IPD) carries a substantial risk of serious health complications and significant mortality, emphasizing the importance of immunization as one of the most effective preventive strategies.
• Health Canada authorized a new product to protect adults 18 years of age and older against IPD on July 15, 2024:
  • Pneu-C-21 (CAPVAXIVE^®, Merck) was authorized for adults 18 years of age and older, with an indication for prevention of IPD caused by 21 serotypes of S. pneumoniae (3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B), and cross-protection against 2 additional serotypes (6C and 15B).

Following a review of the evidence of pneumococcal vaccines, including Pneu-C-21, NACI makes the following strong recommendations for public health program level decision-making:

• Adult pneumococcal immunization programs in Canada should include at least one of Pneu-C-20 or Pneu-C-21.
• One dose of either Pneu-C-20 or Pneu-C-21, regardless of pneumococcal vaccination history with Pneu-C-13, Pneu-C-15 or Pneu-P-23, should be given to:
  • Adults 65 years of age and older
  • Adults under 65 years of age at increased risk of IPD
  • Medical risk factors and certain social, behavioural and environmental conditions can increase the risk of severe IPD illness in adults. A full list of risk conditions can be found within the NACI statement, along with specific recommendations for hematopoietic stem cell transplant recipients.
• NACI will continue to review emerging evidence and update guidance as needed.

To receive a PDF copy of the full NACI statement, please email naci.publications-ccni@phac-aspc.gc.ca. A fully accessible version of the statement will be available online on the NACI web page and updates to the pneumococcal vaccines chapter will be published in the Canadian Immunization Guide (CIG) as soon as possible.

What you need to know

• Pneumococcal disease is the name for any infection caused by the Streptococcus pneumoniae bacteria (S. pneumoniae). Pneumococcal infections can range from ear and sinus infections, to pneumonia, to more serious conditions called invasive pneumococcal disease (IPD). IPD is a severe form of infection that occurs when bacteria enter the bloodstream (bacteremia), leading to sepsis, or enter the central nervous system, causing meningitis.
• Many different serotypes of S. pneumoniae bacteria are circulating in Canada. The most common serotypes that cause disease can vary across different populations and tend to change over time. This is why several vaccines have been developed in recent years to protect against more serotypes of S. pneumoniae bacteria.
• The new Pneu-C-21 vaccine protects against 10 unique serotypes of S. pneumoniae bacteria (9N, 15A, 16F, 17F, 20A, 23A, 23B, 24F, 31 and 35B) that are not included in Pneu-C-20, while Pneu-C-20 vaccine protects against 9 unique serotypes of S. pneumoniae bacteria (1, 4, 5, 6B, 9V, 14, 18C, 19F, and 23F) that are not included in Pneu-C-21.
• NACI is now recommending that either of the high-valency conjugate vaccines (Pneu-C-21 or Pneu-C-20) be used in adult immunization programs. To best determine which vaccine to offer within their jurisdiction, provinces and territories should consider which types of S. pneumoniae bacteria most often affect key populations in their region based on available epidemiologic data. The choice of vaccine may change over time, with changes in the epidemiology.
• NACI strongly recommends that older adults should receive one of the high-valency conjugate vaccines (Pneu-C-21 or Pneu-C-20), along with some key populations at high risk of IPD.
• Age is a major risk factor for IPD, with incidence gradually increasing from age 50 and rising sharply among individuals aged 65 and older. Certain social, behavioural, and environmental factors can also elevate the risk of IPD in adults under 65 years of age. For more information on factors that increase the risk of IPD and make vaccination particularly important, please see the pneumococcal vaccines chapter of the Canadian Immunization Guide (CIG).
• Adults previously vaccinated with another pneumococcal vaccine can receive Pneu-C-21, if at least one year has passed since their last dose. However, most people are not recommended to receive both Pneu-C-21 and Pneu-C-20 vaccines at this time, except some who have had a hematopoietic stem cell transplant.
• The vaccine is generally well tolerated. The most commonly reported adverse events following vaccination with Pneu-C-21 or Pneu-C-20 in adults were injection site reactions (such as pain, redness, swelling), fatigue, headache, and myalgia (muscle pain), which are expected common events after vaccination with any vaccine.
• NACI continues to recommend that pneumococcal vaccines may be administered concurrently (i.e., same day) or at any time before or after other vaccines such as influenza or COVID-19 vaccines.
• There are more pneumococcal vaccines under development, and it is likely that the vaccine options will continue to evolve over time for both adult and pediatric immunization programs.

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