Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link

PneumoRecs VaxAdvisor

Home

Clinical Guidance: Serotype 4

PCV21 contains eight new pneumococcal serotypes not included in PCV15, PCV20, or PPSV23. However, PCV21 doesn’t contain certain pneumococcal serotypes (e.g., serotype 4) included in other pneumococcal vaccines.

In certain adult populations in the Western United States with data (Alaska, Colorado, New Mexico, Navajo Nation, and Oregon), serotype 4 has caused high percentages (i.e., ≥30%) of invasive pneumococcal disease (IPD). We currently don’t know if this is seen in other parts of the Western United States that don’t routinely monitor IPD data.

Typically, individuals living within these geographic areas who develop serotype 4 IPD are adults aged <65 years with specific underlying conditions or risk factors such as alcoholism, chronic lung disease, cigarette smoking, homelessness, and injection drug use. Importantly, these individuals usually haven’t received a PCV containing serotype 4. In such populations, other recommended pneumococcal vaccines (e.g., PCV20 alone or both PCV15 and PPSV23) are expected to provide broader serotype coverage against locally circulating strains compared to PCV21 alone.

Home
Has the patient ever received PCV15, PCV20, or PCV21?
Home
Did the patient receive PCV15, PCV20, or PCV21?
Home
Has the patient ever received PPSV23?
Home
Does the patient have any of the following risk factors?
Risk factors
  • Alcoholism
  • Cerebrospinal fluid (CSF) leak
  • Chronic heart1, liver, or lung2 disease
  • Chronic renal failure
  • Cigarette smoking
  • Cochlear implant
  • Congenital or acquired asplenia
  • Congenital or acquired immumnodeficiency3
  • Diabetes mellitus
  • Generalized malignancy
  • HIV infection
  • Hodgkin disease
  • latrogenic immunosuppression4
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Nephrotic syndrome
  • Sickle cell disease and other hemoglobinopathies
  • Solid organ transplant

Footnotes:
1. Including congestive heart failure and cardiomyopathies, excluding hypertension
2. Including chronic obstructive pulmonary disease, emphysema, and asthma
3. Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
4. Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy

Home
Which of the following risk factors does your patient have?
Close

Please Note: Recommendations will be based on the leading risk factor selected: Cochlear implants and CSF leaks

Close

Please Note: Recommendations will be based on the leading risk factor selected: Immunocompromising conditions

Chronic health conditions
  • Alcoholism
  • Chronic heart1, liver, or lung2 disease
  • Cigarette smoking
  • Diabetes mellitus

Footnotes:
1. Including congestive heart failure and cardiomyopathies, excluding hypertension
2. Including chronic obstructive pulmonary disease, emphysema, and asthma

CSF leak or cochlear implant
  • Cerebrospinal fluid (CSF) leak
  • Cochlear implant
Immunocompromising conditions
  • Chronic renal failure
  • Congenital or acquired asplenia
  • Congenital or acquired immumnodeficiency3
  • Generalized malignancy
  • HIV infection
  • Hodgkin disease
  • latrogenic immunosuppression4
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Nephrotic syndrome
  • Sickle cell disease and other hemoglobinopathies
  • Solid organ transplant

Footnotes:
3. Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
4. Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy

Home
Has the patient ever received PPSV23?
Home
Has the patient ever received PPSV23?
Home
Has the patient ever received PCV13?
Home
Has your patient already received 1 or 2 doses of PPSV23?











































Page last reviewed: September 12, 2024