Carmen Cawley MD FACP
The NEW PREVNAR 21 is the most effective vaccine against pneumococcal pneumonia ever, per preliminary data:
We do recommend pneumococcal pneumonia vaccines to our high-risk patients with recurrent sinusitis, asthma/COPD, immunodeficiency, diabetes, coronary artery diseases, chronic kidney or liver disease, asplenia, patients over 65, patients on immunosuppressants for cancer or autoimmune disease. A general rule is to get another pneumonia vaccine 5 to 10 YEARS AFTER YOUR LAST PNEUMOVAX 23 OR PREVNAR 13 or Prevnar 20.
The Prevnar 20 was approved by the FDA 1/2021 and the Prevnar 21 is a brand-new vaccine just approved tentatively 4/2024 till longer trials are completed. The Prevnar 21 is the first vaccine in 40 years to work on newer strains of pneumococcal pneumonia and the antibody levels are 1.5 times higher or more than previous vaccines. Does that translate into being a more effective vaccine against invasive streptococcal pneumonia than older vaccines? Merck, the manufacturer of Prevnar 21 is reporting is slightly higher incidence of redness, swelling, fatigue, headache, muscle aches and fever. There were 2 serious adverse reactions in the 4000 patients in trials within 30 days of vaccine (one allergic reaction and one cellulitis) but overall serious adverse events were fewer than the Prevnar 15 or the 23 given in the trials.
BOTH PREVNAR VACCINES ARE CONTRAINDICATED IF ALLERGIC TO TDAP VACCINE: the CRM197 is a nontoxic mutant of diphtheria toxin used to make the vaccine more antigenic or reactive to your immune system.
NEW INSTRUCTIONS FOR RSV VACCINES – RSV or respiratory syncytial virus is a flu like illness that can RARELY lead to complications or hospitalization in adults. I have seen no deaths from this illness in my lifetime though the disease is much more serious in children. This a new vaccine category and the vaccines and the studies went on about 7 months and long-term data is only available for a little over 1 year. Neither vaccine has proof of long-term efficacy. In studies of over 10,000 patients. There were 6 more atrial fibrillation cases within a month of both vaccines, but these events evened out and were similar by 6 months. There were very rare serious autoimmune reactions including 1 case of Guillain Barre within 9 days of Abrexvy vaccine and 1 case in Abrysvo trials too. The efficacy is about 65 to 85 % with it being more effective at preventing severe disease in high-risk patients over 60.
I recommend it in high-risk seniors with COPD, asthma or others in immunocompromised states where the benefit is greater than any small risk at this time.