Hello Immunization Partners,

On June 22, 2023, the Advisory Committee on Immunization Practices (ACIP) convened and approved recommendations for the use of 20-valent pneumococcal conjugate vaccine (PCV20) in U.S. children. The ACIP recommendations were adopted by the Centers for Disease Control and Prevention (CDC) Director on June 27, 2023, and are official.

On September 22, 2023, CDC published a Morbidity and Mortality Weekly Report (MMWR) ACIP Updates: Recommendations for the Use of 20-Valent Pneumococcal Conjugate Vaccine in Children ― United States, 2023 with recommendations from the ACIP for use of pneumococcal vaccines in children and adolescents aged less than 19 years in the United States. This report also includes new or updated clinical guidance for implementation from CDC.

The Michigan Department of Health and Human Services (MDHHS) Division of Immunization sent an email on September 8, 2023, regarding the use of PCV20. The following is additional CDC guidance for implementation:

• If only PCV13 is available when the child is scheduled to receive a PCV, PCV13 may be given as previously recommended.
• If a child started the PCV series with PCV13, the child may complete the series with PCV15 or PCV20 without giving additional doses; the PCV series does not need to be restarted.
• For healthy children aged 24-59 months who completed recommended PCV vaccination series with PCV13 (i.e., 4 doses of PCV13 or another age appropriate PCV13 schedule), a supplemental dose of PCV15 or PCV20 is not indicated.
• For children aged 6–18 years with a risk condition who have received PCV13 only at or after age 6 years, either a dose of PCV20 or ≥1 dose of PPSV23 is recommended at least 8 weeks after the last PCV13 dose.
• When PPSV23 is used instead of PCV20 for children aged 6–18 years with an immunocompromising condition, either PCV20 or a second PPSV23 dose is recommended ≥5 years after the first PPSV23 dose.
• Children aged <19 years who are hematopoietic stem cell transplant (HSCT) recipients are recommended to receive 4 doses of PCV20, starting 3–6 months after HSCT. Administer 3 doses of PCV20, 4 weeks apart starting 3–6 months after HSCT. Administer a fourth PCV20 dose ≥6months after the third dose of PCV20 or ≥12 months after HSCT, whichever is later.
• If PCV20 is not available, 3 doses of PCV15 4 weeks apart, followed by a single dose of PPSV23 ≥1 year after HSCT, can be administered. For patients with chronic graft versus host disease (GVHD) who are receiving PCV15, a fourth dose of PCV15 can be administered in place of PPSV23 because these children are less likely to respond to
• A patient’s clinical team is best informed to determine the appropriate timing of vaccination.

In addition, the CDC PneumoRecs Vax Advisor Mobile App for Vaccine Providers was updated on September 28 to reflect CDC's updated pediatric pneumococcal vaccination recommendations. Please note that you might have to reinstall the app for updated guidance.

Thank you for all you do!

Oakland County Health Division, Immunization Action Plan