Review of the vaccination strategy against invasive pneumococcal infections

Objectives of the recommendations

• Update the vaccination strategy against invasive pneumococcal infections in infants, in children aged two years and over – including those at risk of pneumococcal infections – in adolescents, as well as in adults aged 18 to 64 who are at risk and adults aged 65 and over.
• Optimise the population-level impact of vaccination in the context of evolving vaccine availability, taking into account the expanded valency of the available vaccines – 20-valent PREVENAR 20 and 21-valent CAPVAXIVE – and their coverage of serotypes circulating in France, according to population subgroups by age group.

The HAS recommends:

The use of the VPC20 vaccine in infants instead of the current vaccination strategy.

• The HAS recommends the use of the VPC20 vaccine in infants and preterm babies;
• The HAS recommends discontinuing the use of the VPC13 and VPC15 vaccines in infants and preterm babies;
• The VPC20 vaccine can be administered alongside other vaccines recommended for these age groups.
  
  
• The use of the VPC20 vaccine in infants and children at risk of pneumococcal infections (PI) as an alternative to the current vaccination strategy.
• The HAS recommends the use of the VPC20 vaccine in infants and children aged 15 months to under 18 years who are at risk of PI;
• The HAS recommends discontinuing the use of VPC13, VPC15 and VPP23 in children at risk;
• The VPC20 vaccine can be administered concurrently with other vaccines recommended for these age groups.
• The preferred use of the VPC21 vaccine in adults aged 18 to 64 at risk of IP, including welders regularly exposed to welding fumes and metalworkers, and adults aged 65 and over.
• The HAS recommends the preferred use of VPC21 in adults;
• To date, no sequential vaccination schedule combining VPC20 and VPC21 has been studied.
• The HAS does not, at this stage, comment on the relevance and necessity of repeat vaccination following the single dose, in accordance with its marketing authorisation;
• The VPC21 vaccine may be administered concurrently with other vaccines recommended for these age groups.

This position takes into account:

• the epidemiology and impact of pneumococcal infections in France;
• vaccination coverage and serotype coverage of the available vaccines, by target population;
• data on the immunogenicity, tolerability and safety of VPC20 and VPC21;
• the results of mathematical modelling;
• the values and preferences of the target populations;
• the medico-economic impact of the disease;
• the feasibility of implementation (supply and surveillance);
• the acceptability of the recommendations by stakeholders.

The table summarises the HAS’s recommendations on vaccination against pneumococcal infections.

 Summary of the HAS’s recommendations on vaccination against pneumococcal infections.

The HAS recommends that infants who have started a vaccination schedule with VPC13 or VPC15 should continue with VPC20 in accordance with the VPC20 schedule (at 2, 4, 6 and 11 months).

The HAS does not propose a catch-up schedule for adults who have previously been vaccinated with VPC20. For immunocompromised individuals, a specific recommendation is currently being drawn up by the French-speaking Society for Infectious Diseases (SPILF).

The HAS states that the vaccination strategy against pneumococcal infections will be updated in line with changes in the epidemiological situation, advances in scientific knowledge, and marketing authorisations or extensions of indications for pneumococcal vaccines.

The HAS encourages the assessment of the overall impact of the vaccination strategy against pneumococcal infections by conducting surveys to evaluate vaccination coverage among infants, at-risk children, at-risk adults and adults aged 65 and over. The HAS also encourages surveillance networks and researchers to carry out assessments of the impact of the vaccination strategy aimed at reducing the burden of the disease in hospital settings and within the community.

The HAS further calls for an assessment of the duration of protection provided by all vaccines against pneumococcal infections recommended for all age groups, in order to determine the appropriateness of future booster doses, as well as co-administration with other recommended vaccinations in accordance with the immunisation schedule.