View source for Pneumococcal conjugate vaccine

{{Short description|Vaccine against Strep pneumoniae}}
{{Use dmy dates|date=November 2022}}
{{Drugbox
| image              = Prevenar 13.jpg
| caption            = Prevenar 13
| drug_name          = 

<!-- Vacine data -->
| type               = vaccine
| target             = [[Streptococcus pneumoniae]]
| vaccine_type       = conjugate

<!-- Clinical data -->
| pronounce          = 
| tradename          = Prevnar 20, Prevnar 13, Synflorix, others; discontinued Prevnar (PCV7)
| Drugs.com          = {{drugs.com|monograph|pneumococcal-vaccine}}
| MedlinePlus        = a607021
| licence_EU         = <!-- EMA uses INN (or special INN_EMA) -->
| DailyMedID         = Pneumococcal
| licence_US         = <!-- FDA may use generic or brand name (generic name preferred) -->
| pregnancy_AU       = B1
| pregnancy_AU_comment = <ref name="Vaxneuvance APMDS">{{cite web | title=Vaxneuvance APMDS | website=Therapeutic Goods Administration | date=24 January 2022 | url=https://www.tga.gov.au/resources/auspmd/vaxneuvance | access-date=5 February 2022 | archive-date=5 February 2022 | archive-url=https://web.archive.org/web/20220205045646/https://www.tga.gov.au/apm-summary/vaxneuvance | url-status=live }}</ref><ref>{{cite web | title=Updates to the Prescribing Medicines in Pregnancy database | website=Therapeutic Goods Administration | date=21 December 2022 | url=https://www.tga.gov.au/resources/resource/guidance/updates-prescribing-medicines-pregnancy-database | access-date=2 January 2023 | archive-date=3 April 2022 | archive-url=https://web.archive.org/web/20220403064059/https://www.tga.gov.au/updates-prescribing-medicines-pregnancy-database | url-status=live }}</ref><ref name="Prevenar 20 APMDS">https://www.tga.gov.au/resources/auspmd/prevenar-20 {{Webarchive|url=https://web.archive.org/web/20230105011912/https://www.tga.gov.au/resources/auspmd/prevenar-20 |date=5 January 2023 }} {{bare URL inline|date=April 2023}}</ref>
| pregnancy_category = 
| routes_of_administration = [[Intramuscular]]
| class              = 
| ATCvet             = 
| ATC_prefix         = J07
| ATC_suffix         = AL02
| ATC_supplemental   = 

<!-- Legal status -->
| legal_AU           = S4
| legal_AU_comment   = <ref name="Vaxneuvance APMDS" /><ref name="Prevenar 20 APMDS" /><ref>{{cite web | title=Prevenar 20 (Pfizer Australia Pty Ltd) | website=Therapeutic Goods Administration | date=13 January 2023 | url=https://www.tga.gov.au/resources/prescription-medicines-registrations/prevenar-20-pfizer-australia-pty-ltd | access-date=9 April 2023 | archive-date=27 March 2023 | archive-url=https://web.archive.org/web/20230327062424/https://www.tga.gov.au/resources/prescription-medicines-registrations/prevenar-20-pfizer-australia-pty-ltd | url-status=live }}</ref>
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| legal_BR_comment   = 
| legal_CA           = Rx-only
| legal_CA_comment   = /{{nbsp}}Schedule D<ref>{{cite web | title=Summary Basis of Decision (SBD) for Vaxneuvance | website=Health Canada | date=25 February 2022 | url=https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00579&lang=en | access-date=29 May 2022 | archive-date=29 May 2022 | archive-url=https://web.archive.org/web/20220529193011/https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00579&lang=en | url-status=live }}</ref><ref>{{cite web | title=Summary Basis of Decision - Prevnar 20 | website=Health Canada | date=31 August 2022 | url=https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00603&lang=en | access-date=22 September 2022 | archive-date=29 September 2022 | archive-url=https://web.archive.org/web/20220929045440/https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00603&lang=en | url-status=live }}</ref>
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| legal_UK           = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->
| legal_UK_comment   = 
| legal_US           = Rx-only
| legal_US_comment   = <ref name="Prevnar 13 FDA label" /><ref name="Prevnar 20 FDA label" /><ref name="Vaxneuvance FDA label">{{cite web | title=Vaxneuvance- pneumococcal 15-valent conjugate vaccine crm197 protein adsorbed injection, suspension | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1158fa93-ef41-4a29-8252-9251f94c53c8 | access-date=20 August 2021 | archive-date=21 August 2021 | archive-url=https://web.archive.org/web/20210821081841/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1158fa93-ef41-4a29-8252-9251f94c53c8 | url-status=live }}</ref>
| legal_EU           = Rx-only
| legal_EU_comment   = <ref name="Prevenar 13 EPAR" /><ref name="Synflorix EPAR" /><ref name="Vaxneuvance EPAR" /><ref name="Vaxneuvance EU" /><ref name="Apexxnar EPAR" />
| legal_UN           = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment   = 
| legal_status       = Rx-only

<!-- Identifiers -->
| CAS_number         = 
| PubChem            = 
| DrugBank           = 
| ChemSpiderID       = none
| KEGG               = D10455
| KEGG2              = D12205
<!-- | KEGG3              = D12207 -->
| synonyms           = PCV, pneumococcal vaccine, capsular polysaccharides<ref>{{cite web | title=Updates to the Prescribing Medicines in Pregnancy database | website=Therapeutic Goods Administration | date=21 December 2022 | url=https://www.tga.gov.au/resources/resource/guidance/updates-prescribing-medicines-pregnancy-database | access-date=2 January 2023 | archive-date=3 April 2022 | archive-url=https://web.archive.org/web/20220403064059/https://www.tga.gov.au/updates-prescribing-medicines-pregnancy-database | url-status=live }}</ref>

}}

'''Pneumococcal conjugate vaccine''' is a [[pneumococcal vaccine]] and a [[conjugate vaccine]] used to protect [[infant]]s, young children, and adults against disease caused by the [[bacterium]] ''[[Streptococcus pneumoniae]]'' (pneumococcus). It contains purified capsular polysaccharide of pneumococcal serotypes conjugated to a carrier protein to improve antibody response compared to the [[pneumococcal polysaccharide vaccine]]. The [[World Health Organization]] (WHO) recommends the use of the conjugate vaccine in [[Vaccination schedule|routine immunizations]] given to children.<ref>{{cite journal | vauthors=((World Health Organization)) | title = Pneumococcal conjugate vaccines in infants and children under 5 years of age: WHO position paper –February 2019 | journal = Wkly Epidemiol Rec | year = 2019 | volume = 94 | issue = 8 | pages = 85–104 | hdl = 10665/310970}}</ref><ref name="who.int 2019">{{cite web | title=Summary of WHO Position Paper on Pneumococcal conjugate vaccines in infants and children under 5 years of age, February 2019 | website=who.int | date=April 21, 2019 | url=https://www.who.int/immunization/policy/position_papers/who_pp_pcv_2019_summary.pdf | archive-url=https://web.archive.org/web/20220308153642/https://www.who.int/immunization/policy/position_papers/who_pp_pcv_2019_summary.pdf | archive-date=March 8, 2022 | url-status=dead }}</ref>

Vaccine-mediated immunity is "conferred mainly by opsonophagocytic killing of ''S. pneumoniae''."<ref name=":0">{{cite web |date=June 2021 |year=2021 |title=PREVNAR 20- pneumococcal 20-valent conjugate vaccine injection, suspension: Wyeth Pharmaceutical Division of Wyeth Holdings LLC |url=https://labeling.pfizer.com/ShowLabeling.aspx?id=15428 |url-status=live |access-date=9 August 2022 |publisher=Wyeth Pharmaceuticals, LLC (A subsidiary of Pfizer Inc.) |page=11 |publication-place=Philadelphia, PA 19101, US |archive-date=5 September 2022 |archive-url=https://web.archive.org/web/20220905150823/https://labeling.pfizer.com/ShowLabeling.aspx?id=15428 }}</ref>

The most common side effects in children are decreased appetite, fever (only very common in children aged six weeks to five years), irritability, reactions at the site of injection (reddening or hardening of the skin, swelling, pain or tenderness), somnolence (sleepiness) and poor quality sleep.<ref name="Prevenar 13 EPAR" /><ref name=":0" /> In adults and the elderly, the most common side effects are decreased appetite, headaches, diarrhea, fever (only very common in adults aged 18 to 29 years), vomiting (only very common in adults aged 18 to 49 years), rash, reactions at the site of injection, limitation of arm movement, arthralgia and myalgia (joint and muscle pain), chills and fatigue.<ref name="Prevenar 13 EPAR" /><ref name=":0" />

==Brands==
===Pneumosil===
Pneumosil is a decavalent pneumococcal conjugate vaccine produced by the [[Serum Institute of India]]. It contains the serotypes 1, 5, 6A, 6B, 7F, 9V, 14, 19A, 19F, and 23F, and was prequalified by WHO in January 2020.<ref>{{cite web |url=https://www.gavi.org/sites/default/files/document/pcv-profilespdf.pdf |title=Gavi-supported pneumococcal conjugate vaccines profiles to support country decision making |year=2019 |publisher=GAVI |access-date=8 April 2020 |archive-date=19 May 2020 |archive-url=https://web.archive.org/web/20200519081940/https://www.gavi.org/sites/default/files/document/pcv-profilespdf.pdf |url-status=live }}</ref><ref>{{cite press release |title=Pneumosil, the new pneumococcal vaccine, achieves WHO prequalification, a key step toward improving access and affordability |url=https://markets.businessinsider.com/news/stocks/pneumosil-the-new-pneumococcal-vaccine-achieves-who-prequalification-a-key-step-toward-improving-access-and-affordability-1028849941 |publisher=[[Serum Institute of India]] |agency=PR Newswire |date=28 January 2020 |access-date=8 April 2020 |archive-date=17 April 2021 |archive-url=https://web.archive.org/web/20210417183729/https://markets.businessinsider.com/news/stocks/pneumosil-the-new-pneumococcal-vaccine-achieves-who-prequalification-a-key-step-toward-improving-access-and-affordability-1028849941 |url-status=live }}</ref>

===Prevnar===
[[File:Vacuna-prevenar.jpg|thumb|Prevnar vaccine]]
Prevnar 13 (PCV13) is produced by the [[Wyeth]] subsidiary of [[Pfizer]] and it replaces Prevnar (PCV7), the pneumococcal 7-valent conjugate vaccine (PCV7).<ref name="FDA PR 20100224" /><ref>{{cite press release | title=Pfizer And Wyeth Become One: Working Together For A Healthier World | website=Pfizer | date=15 October 2009 | url=https://www.pfizer.com/news/press-release/press-release-detail/pfizer_and_wyeth_become_one_working_together_for_a_healthier_world | access-date=15 December 2022 | archive-date=15 December 2022 | archive-url=https://web.archive.org/web/20221215083304/https://www.pfizer.com/news/press-release/press-release-detail/pfizer_and_wyeth_become_one_working_together_for_a_healthier_world | url-status=live }}</ref> It is a tridecavalent vaccine because it contains thirteen serotypes of pneumococcus (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F).<ref name="Prevnar 13 FDA">{{cite web | title=Prevnar 13 | website=U.S. [[Food and Drug Administration]] (FDA) | date=1 March 2018 | url=https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar-13 | archive-url=https://web.archive.org/web/20191127192849/https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar-13 | archive-date=27 November 2019 | url-status=live | access-date=27 September 2019 | id=STN 125324}} {{PD-notice}}</ref><ref name="Prevnar 13 FDA label">{{cite web | title=Prevnar 13- pneumococcal 13-valent conjugate vaccine injection, suspension | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5d49181b-b974-a5da-3b38-12a3a87bb96b | access-date=20 August 2021 | archive-date=21 August 2021 | archive-url=https://web.archive.org/web/20210821081836/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5d49181b-b974-a5da-3b38-12a3a87bb96b | url-status=live }}</ref> Prevnar 13 was approved for use in the European Union in December 2009.<ref name="Prevenar 13 EPAR">{{cite web | title=Prevenar 13 EPAR | website=[[European Medicines Agency]] (EMA) | date=26 March 2020 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/prevenar-13 | access-date=26 March 2020 | archive-date=26 February 2021 | archive-url=https://web.archive.org/web/20210226205639/https://www.ema.europa.eu/en/medicines/human/EPAR/prevenar-13 | url-status=live }} Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> In February 2010, Prevnar 13 was approved in the United States to replace Prevnar (PCV7), the pneumococcal 7-valent conjugate vaccine (PCV7).<ref name="FDA PR 20100224">{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm201758.htm |title=FDA Approves Pneumococcal Disease Vaccine with Broader Protection |date=24 February 2010 | access-date=9 September 2010 |url-status=dead |archive-url=https://web.archive.org/web/20100911195649/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm201758.htm |archive-date=11 September 2010 }} {{PD-notice}}</ref><ref>{{cite web | title=Prevnar 13 | website=U.S. [[Food and Drug Administration]] (FDA) | date=12 March 2010 | url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201667.htm | archive-url=https://web.archive.org/web/20100312165333/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201667.htm | archive-date=12 March 2010 | url-status=unfit | access-date=27 November 2019}} {{PD-notice}}</ref> After waiting for the outcome of a trial underway in the Netherlands, the [[Centers for Disease Control and Prevention]] (CDC) recommended the vaccine for adults over age 65 in August 2014.<ref>{{cite web |url=http://www.marketwatch.com/story/advisory-committee-on-immunization-practices-votes-to-recommend-pfizers-prevnar-13-vaccine-in-adults-aged-65-years-and-older-2014-08-13 |title=Advisory Committee on Immunization Practices Votes to Recommend Pfizer's Prevnar 13 Vaccine in Adults Aged 65 Years and Older |website=MarketWatch.com |date=13 August 2014 |access-date=27 April 2017 |archive-date=4 March 2016 |archive-url=https://web.archive.org/web/20160304002106/http://www.marketwatch.com/story/advisory-committee-on-immunization-practices-votes-to-recommend-pfizers-prevnar-13-vaccine-in-adults-aged-65-years-and-older-2014-08-13 |url-status=live }}</ref>

Prevnar (PCV7) is a heptavalent vaccine, meaning that it contains the [[cell capsule]] sugars of seven [[serotype]]s of the bacteria ''S. pneumoniae'' (4, 6B, 9V, 14, 18C, 19F, and 23F) conjugated with [[diphtheria]] [[proteins]].<ref name="Prevnar FDA">{{cite web | title=Prevnar | publisher=U.S. [[Food and Drug Administration]] (FDA) | date=25 May 2022 | url=https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar | access-date=22 September 2022 | archive-date=1 September 2022 | archive-url=https://web.archive.org/web/20220901043127/http://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar | url-status=live }}</ref> It was manufactured by [[Wyeth]].<ref name="Prevnar FDA 2">{{cite web | title=Prevnar | publisher=U.S. [[Food and Drug Administration]] (FDA) | date=24 August 2009 | url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm180017.htm | access-date=29 September 2022 | archive-date=22 July 2017 | archive-url=https://wayback.archive-it.org/7993/20170722071713/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm180017.htm | url-status=dead }}</ref><ref name="Wyeth_Prevnar_Product_Flyer">{{cite web|url=http://www.wyeth.com/content/ShowLabeling.asp?id=134|title=Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM<sub>197</sub> Protein)|publisher=Wyeth|year=2006|url-status=dead|archive-url=https://web.archive.org/web/20060615072237/http://www.wyeth.com/content/ShowLabeling.asp?id=134|archive-date=15 June 2006}}</ref> Prevnar (PCV7) was approved for use in the United States in February 2000,<ref name="Prevnar FDA 2" /><ref>{{cite web | url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm137057.htm | title=February 17, 2000 Approval Letter | publisher=U.S. [[Food and Drug Administration]] (FDA) | archive-url=https://web.archive.org/web/20090710171352/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm137057.htm | archive-date=10 July 2009 | url-status=dead}} {{PD-notice}}</ref><ref name="CDC In Depth">{{cite web | title=Pneumococcal Vaccination: What Everyone Should Know | publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=24 January 2022 | url=https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html | access-date=15 December 2022 | archive-date=12 November 2019 | archive-url=https://web.archive.org/web/20191112003154/https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html | url-status=live }} {{PD-notice}}</ref> and vaccination with Prevnar was recommended for all children younger than two years and for unvaccinated children between 24 and 59 months old who were at high risk for pneumococcal infections.<ref name="aap">{{cite journal | vauthors =  | title = American Academy of Pediatrics. Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis | journal = Pediatrics | volume = 106 | issue = 2 Pt 1 | pages = 362–366 | date = August 2000 | pmid = 10920169 | doi = 10.1542/peds.106.2.362 | doi-access =  | title-link = doi | s2cid = 33310899 }}</ref>

Prevnar (PCV7) was produced from the seven most prevalent strains of ''[[Streptococcus pneumoniae]]'' [[bacteria]] in the U.S. The bacterial capsule sugars, a characteristic of these pathogens, are linked (conjugated) to [[CRM197]], a nontoxic recombinant variant of [[diphtheria]] toxin (from cultures of ''[[Corynebacterium diphtheriae]]'').<ref name=":0" /> This produces a more robust immune response (in most healthy persons). Further, aluminum is also added to the vaccine serum because it is an adjuvant, meaning it further enhances the immune response.<ref name=":0" />

The vaccine's [[polysaccharide]] sugars are grown separately in soy peptone broths.<ref name=":0" /> Through [[reductive amination]], the sugars are directly conjugated to the protein carrier CRM<sub>197</sub> to form the [[glycoconjugate]].<ref name=":0" /> CRM<sub>197</sub> is grown in ''C. diphtheriae'' strain C7 in a medium of [[casamino acid]]s and [[yeast extract]]s.<ref>{{cite web |url=http://www.rxlist.com/cgi/generic/prevnar.htm |title=Prevnar (Pneumococcal 7-valent Conjugate) drug description - prescription drugs and medications at RxList |access-date=21 November 2007 |url-status=dead |archive-url=https://web.archive.org/web/20071211081606/http://www.rxlist.com/cgi/generic/prevnar.htm |archive-date=11 December 2007 }}</ref><ref name=":0" />

The Prevnar (PCV7) seven-valent formulation (PCV7) contains [[serotype]]s 4, 6B, 9V, 14, 18C, 19F, and 23F, and resulted in a 98% probability of protection against these strains, which caused 80% of the pneumococcal disease in infants in the U.S. PCV7 is no longer produced.<ref>{{Cite web |url=https://www.who.int/immunization/sage/meetings/2017/october/4_PCV_WG_MERGED_Evidence_to_Rec__SEPT_26.pdf |title=WHO SAGE evidence to recommendations table |access-date=6 April 2020 |archive-date=9 May 2021 |archive-url=https://web.archive.org/web/20210509140221/https://www.who.int/immunization/sage/meetings/2017/october/4_PCV_WG_MERGED_Evidence_to_Rec__SEPT_26.pdf |url-status=live }}</ref>

Prevnar 13 (PCV13) was approved for medical use in the US in 2010.<ref>{{cite web | title=Prevnar 13 | website=U.S. [[Food and Drug Administration]] (FDA) | date=24 February 2010 | url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201667.htm | access-date=15 December 2022 | archive-url=https://wayback.archive-it.org/7993/20170722071714/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201667.htm | archive-date=22 July 2017 | url-status = dead }}</ref> PCV13 contains six additional strains (1, 3, 5, 6A, 19A and 7F).<ref>{{cite journal | title = Licensure of a 13-valent pneumococcal conjugate vaccine (PCV13) and recommendations for use among children - Advisory Committee on Immunization Practices (ACIP), 2010 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 59 | issue = 9 | pages = 258–261 | date = March 2010 | pmid = 20224542 | url = <!-- Official URL --> https://www.cdc.gov/mmwr/pdf/wk/mm5909.pdf | access-date = 29 September 2022 | url-status = live | archive-url = https://web.archive.org/web/20220618113957/https://www.cdc.gov/mmwr/PDF/wk/mm5909.pdf | archive-date = 18 June 2022 | author1 = Centers for Disease Control Prevention (CDC) }}</ref>

In June 2021, the U.S. [[Food and Drug Administration]] (FDA) approved the pneumococcal 20-valent conjugate vaccine, sold under the brand name Prevnar 20 (PCV20), for adults 18 years of age and older.<ref name="FDA Prevnar 20" /><ref name="Prevnar 20 FDA label" /> It is an icosavalent pneumococcal conjugate vaccine, which includes the serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F.<ref name="FDA Prevnar 20">{{cite web |url=https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar-20 |title=Prevnar 20 |date=10 June 2021 |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=20 June 2021 |archive-date=10 June 2021 |archive-url=https://web.archive.org/web/20210610025858/https://www.fda.gov/vaccines-blood-biologics/vaccines/prevnar-20 |url-status=live }} {{PD-notice}}</ref><ref name="Prevnar 20 FDA label">{{cite web | title=Prevnar 20- pneumococcal 20-valent conjugate vaccine injection, suspension | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d4e2cf51-e6a8-4103-bb1d-6120c6474ff8 | access-date=20 August 2021 | archive-date=21 August 2021 | archive-url=https://web.archive.org/web/20210821081836/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d4e2cf51-e6a8-4103-bb1d-6120c6474ff8 | url-status=live }}</ref> In February 2022, the European Medicines Agency approved PCV20 under the brand name Apexxnar.<ref name="Apexxnar EPAR" /><ref name="Apexxnar PR">{{cite press release | title=European Medicines Agency Approves Pfizer's 20-Valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease and Pneumonia in Adults (EU Apexxnar, U.S. Prevnar 20) | website=[[Pfizer]] | date=15 February 2022 | url=https://www.pfizer.com/news/press-release/press-release-detail/european-medicines-agency-approves-pfizers-20-valent | access-date=9 June 2022 | archive-date=7 June 2022 | archive-url=https://web.archive.org/web/20220607163656/https://www.pfizer.com/news/press-release/press-release-detail/european-medicines-agency-approves-pfizers-20-valent | url-status=live }}</ref>

In April 2023, the FDA approved Prevnar 20 for the prevention of invasive disease caused by the 20 different serotypes of Streptococcus pneumoniae contained in the vaccine for individuals six weeks through 17 years of age; and for the prevention of otitis media (ear infection) caused by 7 of the serotypes of Streptococcus pneumoniae contained in the vaccine for children six weeks through 5 years of age.<ref name="FDA PR 20230428">{{cite web | title=FDA Roundup: April 28, 2023 | website=U.S. Food and Drug Administration | date=28 April 2023 | url=https://www.fda.gov/news-events/press-announcements/fda-roundup-april-28-2023 | access-date=29 April 2023 | archive-date=29 April 2023 | archive-url=https://web.archive.org/web/20230429053758/https://www.fda.gov/news-events/press-announcements/fda-roundup-april-28-2023 | url-status=live }} {{PD-notice}}</ref>

On June 22, 2023, the [[Advisory Committee on Immunization Practices]] (ACIP) approved PCV20 (Prevnar 20) for use in U.S. children.<ref>{{Cite journal |last=CDCMMWR |date=2023 |title=ACIP Updates: Recommendations for Use of 20-Valent Pneumococcal Conjugate Vaccine in Children ― United States, 2023 |url=https://www.cdc.gov/mmwr/volumes/72/wr/mm7239a5.htm |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=72 |issue=39 |page=1072 |doi=10.15585/mmwr.mm7239a5 |issn=0149-2195 |pmc=10545431 |pmid=37768876}}</ref>

===Synflorix===
Synflorix (PCV10) is produced by [[GlaxoSmithKline]]. It is a decavalent vaccine and thus contains ten serotypes of pneumococcus (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F) which are conjugated to a carrier protein. Synflorix received a positive opinion from the [[European Medicines Agency]] (EMA) for use in the European Union in January 2009,<ref>{{cite web|url=http://www.emea.europa.eu/pdfs/human/opinion/Synflorix_1312009en.pdf|title=EMEA Document|website=Emea.europa.eu|access-date=27 April 2017|archive-url=https://web.archive.org/web/20090219223949/http://www.emea.europa.eu/pdfs/human/opinion/Synflorix_1312009en.pdf|archive-date=19 February 2009|url-status=dead}}</ref> and GSK received European Commission authorization to market Synflorix in March 2009.<ref>{{cite press release|url=http://www.gsk.com/media/pressreleases/2009/2009_pressrelease_10039.htm|title=GSK Release|website=Gsk.com|access-date=27 April 2017|url-status=dead|archive-url=https://web.archive.org/web/20090804042243/http://www.gsk.com/media/pressreleases/2009/2009_pressrelease_10039.htm|archive-date=4 August 2009}}</ref><ref name="Synflorix EPAR">{{cite web | title=Synflorix EPAR | website=[[European Medicines Agency]] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/synflorix | access-date=13 July 2020 | archive-date=8 January 2021 | archive-url=https://web.archive.org/web/20210108010508/https://www.ema.europa.eu/en/medicines/human/EPAR/synflorix | url-status=live }}</ref>

===Vaxneuvance===
Vaxneuvance is a pneumococcal 15-valent conjugate vaccine created by Merck that was approved for medical use in the United States in July 2021.<ref name="Vaxneuvance FDA label"/><ref name="FDA Vaxneuvance">{{cite web | title=Vaxneuvance | website=U.S. [[Food and Drug Administration]] (FDA) | date=30 July 2021 | url=https://www.fda.gov/vaccines-blood-biologics/vaccines/vaxneuvance | access-date=20 August 2021 | archive-date=21 August 2021 | archive-url=https://web.archive.org/web/20210821080521/https://www.fda.gov/vaccines-blood-biologics/vaccines/vaxneuvance | url-status=live }} {{PD-notice}}</ref> The vaccine was developed under the code name "V114".<ref>{{cite web |date=27 January 2022 |title=GRADE: 15-valent pneumococcal conjugate vaccine (PCV15) in series with 23-valent pneumococcal conjugate vaccine (PPSV23) for adults aged ≥65 years {{!}} CDC |url=https://www.cdc.gov/vaccines/acip/recs/grade/pneumo-PCV15-PPSV23-age-based.html |access-date=9 August 2022 |website=www.cdc.gov |language=en-us |archive-date=9 August 2022 |archive-url=https://web.archive.org/web/20220809141204/https://www.cdc.gov/vaccines/acip/recs/grade/pneumo-PCV15-PPSV23-age-based.html |url-status=live }}</ref> It is identical to PCV13, except that it adds serotypes 22F and 33F.<ref name=":1">{{cite journal | vauthors = Stacey HL, Rosen J, Peterson JT, Williams-Diaz A, Gakhar V, Sterling TM, Acosta CJ, Nolan KM, Li J, Pedley A, Benner P, Abeygunawardana C, Kosinski M, Smith WJ, Pujar H, Musey LK | display-authors = 6 | title = Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV-15) compared to PCV-13 in healthy older adults | journal = Human Vaccines & Immunotherapeutics | volume = 15 | issue = 3 | pages = 530–539 | date = 2019 | pmid = 30648919 | pmc = 6605726 | doi = 10.1080/21645515.2018.1532249 }}</ref> These two serotypes are particularly important because, after "widespread use of the PCV13…[vaccine] in many countries," these two serotypes are now "among leading serotypes causing IPD in children and adults."<ref name=":1" />

Vaxneuvance is indicated for the active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F and 33F in adults 18 years of age and older.<ref name="Vaxneuvance FDA label"/><ref name="FDA Vaxneuvance" /><ref>{{cite press release | title=Merck Announces U.S. FDA Approval of Vaxneuvance (Pneumococcal 15-valent Conjugate Vaccine) for the Prevention of Invasive Pneumococcal Disease in individuals 6 weeks of age and older Caused by 15 Serotypes | publisher=Merck | via=Business Wire | date=16 July 2021 | url=https://www.businesswire.com/news/home/20210716005480/en/Merck-Announces-U.S.-FDA-Approval-of-VAXNEUVANCE%E2%84%A2-Pneumococcal-15-valent-Conjugate-Vaccine-for-the-Prevention-of-Invasive-Pneumococcal-Disease-in-Adults-18-Years-and-Older-Caused-by-15-Serotypes | access-date=20 August 2021 | archive-date=21 August 2021 | archive-url=https://web.archive.org/web/20210821083113/https://www.businesswire.com/news/home/20210716005480/en/Merck-Announces-U.S.-FDA-Approval-of-VAXNEUVANCE%E2%84%A2-Pneumococcal-15-valent-Conjugate-Vaccine-for-the-Prevention-of-Invasive-Pneumococcal-Disease-in-Adults-18-Years-and-Older-Caused-by-15-Serotypes | url-status=live }}</ref>

On 14 October 2021, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Vaxneuvance, intended for prophylaxis against pneumococcal pneumonia and associated invasive disease.<ref name="Vaxneuvance: Pending EC decision" /> The applicant for this medicinal product is Merck Sharp & Dohme B.V.<ref name="Vaxneuvance: Pending EC decision">{{cite web | title=Vaxneuvance: Pending EC decision | website=[[European Medicines Agency]] (EMA) | date=13 October 2021 | url=https://www.ema.europa.eu/en/medicines/human/summaries-opinion/vaxneuvance | access-date=15 October 2021 | archive-date=18 October 2021 | archive-url=https://web.archive.org/web/20211018120605/https://www.ema.europa.eu/en/medicines/human/summaries-opinion/vaxneuvance | url-status=live }} Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> Vaxneuvance was approved for medical use in the European Union in December 2021.<ref name="Vaxneuvance EPAR">{{cite web | title=Vaxneuvance EPAR | website=[[European Medicines Agency]] (EMA) | date=12 October 2021 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/vaxneuvance | access-date=17 January 2022 | archive-date=18 January 2022 | archive-url=https://web.archive.org/web/20220118182730/https://www.ema.europa.eu/en/medicines/human/EPAR/vaxneuvance | url-status=live }} Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref><ref name="Vaxneuvance EU">{{cite web | title=Vaxneuvance | website=Union Register of medicinal products | url=https://ec.europa.eu/health/documents/community-register/html/h1591.htm | access-date=11 January 2022 | archive-date=11 January 2022 | archive-url=https://web.archive.org/web/20220111231101/https://ec.europa.eu/health/documents/community-register/html/h1591.htm | url-status=live }}</ref>

==Schedule of vaccination==
{{Further|Vaccination schedule}}
As with all immunizations, whether it is available or required, and under what circumstances, varies according to the decisions made by local public health agencies.

Children under the age of two years fail to mount an adequate response to the 23-valent adult vaccine, and so a pneumococcal conjugate vaccine is used. While this covers only seven strains out of more than ninety strains, these seven strains cause 80% to 90% of cases of severe pneumococcal disease, and it is considered to be nearly 100% effective against these strains.<ref>{{cite web|url-status=dead|url=http://www.health.vic.gov.au/immunisation/factsheets/pneumo_child.htm|title=Childhood Pneumococcal Disease|archiveurl=https://web.archive.org/web/20061025233540/http://www.health.vic.gov.au/immunisation/factsheets/pneumo_child.htm |archive-date=25 October 2006|date=21 March 2006}} - information on the disease and the Prevnar vaccine, from the Victoria State (Australia) government. Includes possible side effects.</ref>

===United Kingdom===
The [[vaccination schedule#UK|UK childhood vaccination schedule]] for infants born after 31 December 2019, consists of a primary course of one dose at twelve weeks of age with a second dose at one year of age.<ref>{{cite web|url = https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/|title = NHS vaccinations and when to have them|date = 31 July 2019|access-date = 3 September 2021|archive-date = 17 December 2021|archive-url = https://web.archive.org/web/20211217103237/https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/|url-status = live}}</ref><ref name="greenbook"/> For infants born before 1 January 2020 and those in Scotland, the childhood vaccination schedule consists of a primary course of two doses at eight and sixteen weeks of age with a final third dose at one year of age.<ref name="greenbook"/>

Children at special risk (e.g., [[sickle cell disease]] and [[asplenia]]) require as full protection as can be achieved using the conjugated vaccine, with the more extensive polysaccharide vaccine given after the second year of life:<ref name="greenbook"/>

{| class="wikitable"
|+'''Vaccination schedule for children at special risk'''<ref name="greenbook">{{cite book | chapter=Chapter 25: Pneumococcal | chapter-url=https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25 | title=Immunisation against infectious disease | publisher=Public Health England | veditors = Ramsay M | url=https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book | date=January 2020 | access-date=3 September 2021 | archive-date=12 November 2019 | archive-url=https://web.archive.org/web/20191112005859/https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25 | url-status=live }}</ref>
|- style="text-align:center;"
|| '''Age''' || style="text-align:center;"|'''2–6 months''' || style="text-align:center;"|'''7–11 months''' || style="text-align:center;"|'''12–23 months'''
|- style="text-align:center;"
| rowspan="2"| '''Conjugated vaccine''' || style="text-align:center;"| 3 × monthly dose || style="text-align:center;"| 2 × monthly dose || rowspan="2" style="text-align:center;"| 2 doses, 2 months apart
|-
| colspan="2" style="text-align:center;"| Further dose in second year of life
|- style="text-align:center;"
|| '''23-valent vaccine''' || colspan="3" style="text-align:center;"| Then after 2nd birthday single dose of 23-valent
|}

===United States===
In 2001, the [[Centers for Disease Control and Prevention]] (CDC), upon advice from its [[Advisory Committee on Immunization Practices]] (ACIP), recommended the vaccine be administered to every infant and young child in the United States. The resulting demand outstripped production, creating shortages not resolved until 2004. All children, according to the U.S. [[vaccination schedule]], should receive four doses, at two months, four months, six months, and again between one year and fifteen months of age.<ref>{{cite web | title=Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2019 | website=[[Centers for Disease Control and Prevention]] (CDC) | date=5 February 2019 | url=https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html | access-date=3 November 2019 | archive-date=6 March 2016 | archive-url=https://web.archive.org/web/20160306220930/http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html | url-status=live }}</ref><ref>{{cite journal | vauthors = Nuorti JP, Whitney CG | title = Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 59 | issue = RR-11 | pages = 1–18 | date = December 2010 | pmid = 21150868 | doi =  | url = https://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf | access-date = 20 November 2021 | url-status = live | archive-url = https://web.archive.org/web/20210902235514/https://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf | archive-date = 2 September 2021 }}</ref>

The CDC updated the pneumococcal vaccine guidelines for adults 65 years of age or older in 2019.<ref>{{cite journal | vauthors = Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T | title = Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 46 | pages = 1069–1075 | date = November 2019 | pmid = 31751323 | pmc = 6871896 | doi = 10.15585/mmwr.mm6846a5 | url = https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a5-H.pdf | access-date = 20 November 2021 | url-status = live | archive-url = https://web.archive.org/web/20211120064309/https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6846a5-H.pdf | archive-date = 20 November 2021 }}</ref>

In October 2021, the CDC recommended that adults 65 years of age or older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15).<ref name="ACIP Recommendations" /> If PCV15 is used, this should be followed by a dose of PPSV23.<ref name="ACIP Recommendations">{{cite web | title=ACIP Vaccine Recommendations and Schedules | website=[[Centers for Disease Control and Prevention]] (CDC) | url=https://www.cdc.gov/vaccines/acip/recommendations.html | access-date=19 November 2021 | archive-date=20 November 2021 | archive-url=https://web.archive.org/web/20211120063030/https://www.cdc.gov/vaccines/acip/recommendations.html | url-status=live }} {{PD-notice}}</ref> The CDC recommended that adults aged 19 to 64 years with certain underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15).<ref name="ACIP Recommendations" />

==Efficacy==
[[File:US incidence of invasive streptococcal disease before and after vaccine introduction.jpg|thumb|left|alt=United States incidence of invasive pneumococcal disease before and after introduction of the 7-valent and 13-valent pneumococcal vaccines.|United States incidence of invasive pneumococcal disease before and after introduction of the 7-valent and 13-valent pneumococcal vaccines.<ref>{{cite web |url=https://www.cdc.gov/abcs/reports-findings/surv-reports.html |title=CDC - ABCs: Surveillance Reports main page - Active Bacterial Core surveillance |date=19 July 2021 |access-date=10 September 2017 |archive-date=1 December 2020 |archive-url=https://web.archive.org/web/20201201131012/https://www.cdc.gov/abcs/reports-findings/surv-reports.html |url-status=live }}</ref>]]
Prevnar-7 is designed to stop seven of about ninety pneumococcal serotypes which have the potential to cause invasive [[pneumococcal disease]] (IPD). In 2010, a 13-valent vaccine was introduced. Each year, IPD kills approximately one million children worldwide.<ref>{{cite web | vauthors = Allen A |url= http://www.slate.com/id/2168854/pagenum/all/ |title=What if a vaccine makes room for a new strain of a disease? |website=Slate.com |date=21 June 2007 |access-date=27 April 2017 |archive-date=18 May 2011 |archive-url=https://web.archive.org/web/20110518204510/http://www.slate.com/id/2168854/pagenum/all |url-status=live }}</ref> Since approval, Prevnar's [[vaccine efficacy|efficacy]] in preventing IPD has been documented by a number of [[epidemiology|epidemiologic]] studies.<ref name="pmid12724479">{{cite journal | vauthors = Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, Facklam RR, Jorgensen JH, Schuchat A | display-authors = 6 | title = Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine | journal = The New England Journal of Medicine | volume = 348 | issue = 18 | pages = 1737–1746 | date = May 2003 | pmid = 12724479 | doi = 10.1056/NEJMoa022823 | doi-access = free }}</ref><ref name="pmid16609088">{{cite journal | vauthors = Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, Lexau CA, Thomas AR, Harrison LH, Reingold AL, Hadler JL, Farley MM, Anderson BJ, Schaffner W | display-authors = 6 | title = Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine | journal = JAMA | volume = 295 | issue = 14 | pages = 1668–1674 | date = April 2006 | pmid = 16609088 | doi = 10.1001/jama.295.14.1668 | doi-access =  }}</ref><ref name="pmid17071283">{{cite journal | vauthors = Whitney CG, Pilishvili T, Farley MM, Schaffner W, Craig AS, Lynfield R, Nyquist AC, Gershman KA, Vazquez M, Bennett NM, Reingold A, Thomas A, Glode MP, Zell ER, Jorgensen JH, Beall B, Schuchat A | display-authors = 6 | title = Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study | journal = Lancet | volume = 368 | issue = 9546 | pages = 1495–1502 | date = October 2006 | pmid = 17071283 | doi = 10.1016/S0140-6736(06)69637-2 | url = https://zenodo.org/record/1259803 | access-date = 5 July 2019 | url-status = live | s2cid = 11834808 | archive-url = https://web.archive.org/web/20201205182840/https://zenodo.org/record/1259803 | archive-date = 5 December 2020 }}</ref> There is evidence that other people in the same household as a vaccinee also become relatively protected.<ref>{{cite journal | vauthors = Millar EV, Watt JP, Bronsdon MA, Dallas J, Reid R, Santosham M, O'Brien KL | title = Indirect effect of 7-valent pneumococcal conjugate vaccine on pneumococcal colonization among unvaccinated household members | journal = Clinical Infectious Diseases | volume = 47 | issue = 8 | pages = 989–996 | date = October 2008 | pmid = 18781875 | doi = 10.1086/591966 | doi-access = free }}</ref>
There is evidence that routine childhood vaccination reduces the burden of pneumococcal disease in adults and especially high-risk adults, such as those living with [[HIV]]/[[AIDS]].<ref name="Siemieniuk 2011">{{cite journal | vauthors = Siemieniuk RA, Gregson DB, Gill MJ | title = The persisting burden of invasive pneumococcal disease in HIV patients: an observational cohort study | journal = BMC Infectious Diseases | volume = 11 | pages = 314 | date = November 2011 | pmid = 22078162 | pmc = 3226630 | doi = 10.1186/1471-2334-11-314 | doi-access = free }}</ref>

The vaccine is, however, primarily developed for the U.S. and European epidemiological situation, and therefore it has only a limited coverage of serotypes causing serious pneumococcal infections in most developing countries.<ref name="pmid17324490">{{cite journal | vauthors = Barocchi MA, Censini S, Rappuoli R | title = Vaccines in the era of genomics: the pneumococcal challenge | journal = Vaccine | volume = 25 | issue = 16 | pages = 2963–2973 | date = April 2007 | pmid = 17324490 | doi = 10.1016/j.vaccine.2007.01.065 }}</ref>

==Adverse reactions==

Local reactions such as pain, swelling, or redness occur in up to 50% of those vaccinated with PCV13; of these, 8% are considered severe. Local reactions are more likely after the 4th dose than the earlier doses.<ref name=Pink2017/> In clinical trials, fever greater than 100.4 F (38 C) was reported at a rate of 24-35% following any dose in the primary series and nonspecific symptoms such as decreased appetite or irritability occur in up to 80% of recipients.<ref name=Pink2017/> In a vaccine  safety datalink study, [[febrile seizures]] occurred in roughly 1 in 83,000 to 1 in 6,000 children given PCV 13, and 1 in 21,000 to 1 in 2,000 of those who were given PCV13 and trivalent [[influenza vaccine]] at the same time.<ref name="Pink2017">{{cite web | vauthors = Gierke R, Wodi P, Kobayashi M, Hall E, Hamborsky J |title=Pinkbook Pneumococcal Epidemiology of Vaccine-Preventable Diseases |url=https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html#contraindications |archive-url=https://web.archive.org/web/20220901045810/https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html |archive-date=1 September 2022 |access-date=10 December 2017 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |name-list-style=vanc}}</ref>

==Evidence supporting addition to routine vaccination schedules==

After introduction of the pneumococcal conjugate vaccine in 2000, several studies described a decrease in invasive pneumococcal disease in the United States. One year after its introduction, a group of investigators found a 69% drop in the rate of invasive disease in those of less than two years of age.<ref name="pmid12724479"/> By 2004, all-cause pneumonia admission rates had declined by 39% (95% CI 22–52) and rates of hospitalizations for pneumococcal meningitis decreased by 66% (95% CI 56.3-73.5) in children younger than 2.<ref name="pmid17416262">{{cite journal | vauthors = Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR | title = Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis | journal = Lancet | volume = 369 | issue = 9568 | pages = 1179–1186 | date = April 2007 | pmid = 17416262 | doi = 10.1016/S0140-6736(07)60564-9 | s2cid = 26494828 }}</ref><ref name="pmid18433334">{{cite journal | vauthors = Tsai CJ, Griffin MR, Nuorti JP, Grijalva CG | title = Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States | journal = Clinical Infectious Diseases | volume = 46 | issue = 11 | pages = 1664–1672 | date = June 2008 | pmid = 18433334 | pmc = 4822508 | doi = 10.1086/587897 }}</ref>

Rates of invasive pneumococcal disease among adults have also declined since the introduction of the vaccine.<ref name="pmid12724479"/><ref name="pmid18433334"/>

==Vaccination in low-income countries==
<!-- Deleted image removed: [[Image:WorldPneumoniaDeaths.gif|thumb|right|300px|Annual world deaths in children under 5 due to pneumococcal disease]] -->
Pneumococcal disease is the leading vaccine-preventable killer of young children worldwide, according to the [[World Health Organization]] (WHO). It killed more than 500,000 children younger than five years of age in 2008 alone.<ref name="Lancet 2009">{{cite journal | vauthors = O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T | display-authors = 6 | title = Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates | journal = Lancet | volume = 374 | issue = 9693 | pages = 893–902 | date = September 2009 | pmid = 19748398 | doi = 10.1016/S0140-6736(09)61204-6 | s2cid = 18964449 }}</ref> Approximately ninety percent of these deaths occur in the developing world.<ref name="Lancet 2009"/> Historically 15–20 years pass before a new vaccine reaches one quarter of the population of the developing world.<ref>{{cite web|url=http://www.pneumoadip.com/about_us/need_for_pneumoadip/|archive-url=https://web.archive.org/web/20210827050206/http://www.pneumoadip.com/about_us/need_for_pneumoadip/|url-status=dead|archive-date=27 August 2021|title=PneumoADIP - Need for PneumoADIP|website=Pneumoasdip.com|access-date=27 April 2017}}</ref>

[[PneumoADIP|Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP)]] was a [[Global Alliance for Vaccines and Immunization|GAVI Alliance (GAVI)]] funded project to accelerate the introduction of pneumococcal vaccinations into low-income countries through partnerships between countries, donors, academia, international organizations and industry. GAVI continues this work and as of March 2013, 25 GAVI-eligible and supported countries have introduced the pneumococcal conjugate vaccine. Further, 15 additional GAVI countries have plans to introduce the vaccine into their national immunization program and 23 additional countries have approved GAVI support to introduce the vaccine.<ref name="VIMS Report">{{cite journal|author=Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center|title=VIMS Report: Global vaccine introduction|year=2013|url=http://www.jhsph.edu/research/centers-and-institutes/ivac/vims/IVAC-VIMS-Report-2013-03.pdf|website=Jhsph.edu|access-date=27 April 2017|archive-date=3 March 2016|archive-url=https://web.archive.org/web/20160303233204/http://www.jhsph.edu/research/centers-and-institutes/ivac/vims/IVAC-VIMS-Report-2013-03.pdf|url-status=live}}</ref>

== Society and culture ==
=== Legal status ===
On 16 December 2021, the [[Committee for Medicinal Products for Human Use]] (CHMP) of the [[European Medicines Agency]] (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Apexxnar, intended for prophylaxis against pneumococcal pneumonia and associated invasive disease.<ref name="Apexxnar: Pending EC decision" /> The applicant for this medicinal product is Pfizer Europe MA EEIG.<ref name="Apexxnar: Pending EC decision">{{cite web | title=Apexxnar: Pending EC decision | website=[[European Medicines Agency]] (EMA) | date=15 December 2021 | url=https://www.ema.europa.eu/en/medicines/human/summaries-opinion/apexxnar | access-date=18 December 2021 | archive-date=17 December 2021 | archive-url=https://web.archive.org/web/20211217113403/https://www.ema.europa.eu/en/medicines/human/summaries-opinion/apexxnar | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> Apexxnar was approved for medical use in the European Union in February 2022.<ref name="Apexxnar EPAR">{{cite web | title=Apexxnar EPAR | website=[[European Medicines Agency]] (EMA) | date=14 December 2021 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/apexxnar | access-date=2 March 2022 | archive-date=3 March 2022 | archive-url=https://web.archive.org/web/20220303051238/https://www.ema.europa.eu/en/medicines/human/EPAR/apexxnar | url-status=live }}</ref><ref>{{cite web | title=Apexxnar Product information | website=Union Register of medicinal products | url=https://ec.europa.eu/health/documents/community-register/html/h1612.htm | access-date=3 March 2023 | archive-date=4 March 2023 | archive-url=https://web.archive.org/web/20230304092724/https://ec.europa.eu/health/documents/community-register/html/h1612.htm | url-status=live }}</ref>

===Economics===
Prevnar 13 is Pfizer's best-selling product.<ref name=10K>{{cite web | url=https://s21.q4cdn.com/317678438/files/doc_financials/2020/ar/PFE-2020-Form-10K-FINAL.pdf | title=Pfizer Inc. 2020 Form 10-K Annual Report | publisher=Pfizer | access-date=21 August 2021 | archive-date=23 March 2021 | archive-url=https://web.archive.org/web/20210323212110/https://s21.q4cdn.com/317678438/files/doc_financials/2020/ar/PFE-2020-Form-10K-FINAL.pdf | url-status=live }}</ref> It had annual sales of {{US$|5.85}}{{nbsp}}billion in 2020.<ref name=10K /><ref name="statnews-covid19">{{cite web | vauthors = Herper M |date=24 August 2020 |title=In the race for a Covid-19 vaccine, Pfizer turns to a scientist with a history of defying skeptics — and getting results |url=https://www.statnews.com/2020/08/24/pfizer-edge-in-the-race-for-a-covid-19-vaccine-could-be-a-scientist-with-two-best-sellers-to-her-credit/ |access-date=2 December 2020 |website=[[Stat (website)|Stat News]] |archive-date=21 December 2020 |archive-url=https://web.archive.org/web/20201221043851/https://www.statnews.com/2020/08/24/pfizer-edge-in-the-race-for-a-covid-19-vaccine-could-be-a-scientist-with-two-best-sellers-to-her-credit/ |url-status=live }}</ref>

== Research ==
Merck is investigating a 21-valent vaccine (code named V116) against pneumococcus serotypes.<ref name="NCT05393037" /> The vaccine is geared towards persons living with HIV.<ref name="NCT05393037">{{cite web | title=Safety and Immunogenicity of V116 in Adults Living With Human Immunodeficiency Virus (HIV) (V116-007, STRIDE-7) | website=ClinicalTrials.gov | date=26 May 2022 | url=https://clinicaltrials.gov/ct2/show/NCT05393037 | access-date=29 September 2022 | archive-date=9 August 2022 | archive-url=https://web.archive.org/web/20220809142346/https://clinicaltrials.gov/ct2/show/NCT05393037 | url-status=live }}</ref>

== References ==
{{Reflist}}

== Further reading ==
* {{cite book | vauthors = ((Centers for Disease Control and Prevention)) | chapter = Chapter 17: Pneumococcal Disease | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html | veditors = Hamborsky J, Kroger A, Wolfe S | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | edition = 13th | publisher = Public Health Foundation | location = Washington, D.C. | year = 2015 | url = https://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html }}

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* {{cite web | title=Pneumococcal Conjugate Vaccine Information Statement | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=February 2022 | url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv13.html }}

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