Recomendación del Comité Asesor en Vacunas y Estrategias de Inmunización-CAVEI sobre vacunación neumocócica

Resumen

In Chile, childhood pneumococcal vaccination has significantly reduced the incidence of invasive disease caused by serotypes included in the PCV13 vaccine, although infections from some vaccine serotypes, such as 3 and 19A, persist, and others not included, such as 24F and 22F, have emerged. Among older adults, the disease burden remains high despite PPSV23 vaccination, suggesting limited effectiveness in this group, possibly associated with immunosenescence. New higher-valency conjugate vaccines, such as PCV15, PCV20, and PCV21, have demonstrated strong immunogenicity and safety profiles, with some nuances: PCV15 elicits a stronger response to certain key serotypes, while PCV20 offers broader coverage against serotypes currently prevalent in Chile. Serotypes identified in IPD cases in Chile in 2024 showed that 42% were included in PCV13, 47% in PCV15, 64% in PCV20, and up to 76% in PCV21 among older adults.

While pediatric coverage exceeds 90%, adults tend to delay vaccination beyond the recommended age of 65. Available evidence indicates that conjugate vaccines provide better protection than polysaccharide vaccines, especially in older adults, and may offer additional benefits such as reducing non-invasive pneumococcal infections, lowering antibiotic use, decreasing antimicrobial resistance, herd immunity, and preventing colonization.

The clinical impact of replacing PCV13 with higher-valency vaccines remains uncertain due to the lack of efficacy and effectiveness studies, requiring careful evaluation of the balance between expanded coverage and protection against shared serotypes.

Based on the analysis presented in this document, CAVEI recommends replacing PCV13 with PCV20 in the National Immunization Program, maintaining the 2+1 schedule (at 2 and 4 months with a booster at 12 months) for infants and the 3+1 schedule (at 2, 4, and 6 months with a booster at 12 months) for preterm infants. For adults, CAVEI recommends replacing PPSV23 with PCV21, as it includes the most prevalent serotypes in this population in Chile; if PCV21 is unavailable, use the highest-valency conjugate vaccine available. Additionally, it is recommended to lower the starting age for vaccination to 60 years. For immunocompromised individuals, CAVEI recommends administering PCV21 for adults over 18 years and PCV20 for children, replacing PPSV23 and PCV13, respectively.