Pneumococcal Diseases Require Constant Vaccine Development | NCPA 2025

As Streptococcus pneumoniae (S. pneumoniae)bacteria evolves over time, vaccine development is forced to follow suit in order to keep patients protected against pneumococcal diseases and their shifting serotypes, according to a session presented at the National Community Pharmacists Association (NCPA) 2025 Annual Convention & Expo.¹

In her presentation, Jeannie Grubbs, PharmD, manager at Publix Pharmacy, discussed the “shifting epidemiology” of pneumococcal vaccines for adults. She provided the pharmacist audience with insights on available pneumococcal vaccines, recommendations for specific adult populations, and general trends of pneumococcal diseases in the US.

She began her session by exploring the shift in serotype distribution among US patients and how that has caused continuous vaccine development for pneumococcal diseases.

“In 2005, we see this leveling off. What happened? The serotype shift occurred,” said Grubbs.¹ “So now, the 7 [serotypes] that were in that vaccine are not necessarily the serotypes that are protecting the patient population, so we're seeing a leveling off. A new vaccine came on the market, Prevnar 13 (pneumococcal 13-valent conjugate vaccine). [It] protected against 13 different stereotypes.”

READ MORE: Leading Cause of Meningitis Shifts from S. Pneumoniae to K. Pneumoniae

Before diving into the most recent development of pneumococcal conjugate vaccines (PCVs), Grubbs provided a brief history of vaccine approvals, how they impacted the distribution of S. pneumoniae, and why that has led to further development of new vaccines.

Prior to the 21st century, the only protection against pneumococcal disease was through the pneumococcal polysaccharide vaccine (PPSV), which originally was the 14-valent PPSV (PPSV14). That was later replaced by PPSV23 (Pneumovax 23) in 1983, according to the CDC.²

However, protection against S. pneumoniae and pneumococcal disease wasn’t revolutionized until the year 2000, when the FDA approved the first PCV—Prevnar 7, or PCV7. This approval was crucial for populations most at risk of pneumococcal disease because of PCVs’ ability to outperform PPSVs.

“[Before PCVs], there was only a polysaccharide [vaccine], which was Pneumovax 23. We can't really get polysaccharide vaccines to a child, because it just doesn't stick; it doesn't stay,” continued Grubbs.¹ “Their memory cells do not remember. We only could give those patients conjugate vaccines.”

Protecting against 7 of S. pneumoniae’s 100-plus serotypes, PCV7 was at first a saving grace for pediatric populations. However, protection began waning by 2005, opening the door for development of PCV13 (Prevnar 13), which protected against the same 7 serotypes as PCV7, plus an additional 6 serotypes (1, 3, 5, 6A, 7F, and 19A).²

This trend in vaccine development and serotype shifts, as Grubbs hammered home throughout most of her presentation, has continued since. And according to her, these trends are expected to continue throughout most working pharmacists’ careers.¹

Today, there are 3 different PCVs available for both the pediatric and older adult populations, including PCV15, PCV20, and PCV21. PPSV23 is also available for children 2 to 18, or for older adults that have already received PCV13 or PCV15.³ With 4 vaccines currently available for protection against pneumococcal disease, Grubbs helped NCPA attendees understand the proper approaches for PCV recommendations and how real-world data backs the use of specific vaccine regimens for certain populations.¹

“The question should be, ‘Are we covering the right serotypes that we're seeing currently?’ That's what, as clinicians, we need to think about and do the research, create the package inserts, see if the right serotypes are being covered,” said Grubbs. “Because of this, we're seeing Prevnar 20 having about 52% coverage of the current cases we're seeing, where Capvaxive is going to be covering 84% of the serotype coverage that we're seeing here in the US.”

Throughout her presentation, Grubbs focused on the 2 most utilized pneumococcal vaccines for US adults: PCV21 (Capvaxive) and PCV20 (Prevnar 20). As serotype distribution among the population evolves over time, vaccine manufacturers have also shifted which serotypes their products protect against. According to the serotypes that are common among S. pneumoniae infection at the current moment, PCV21 has been found to protect against 84% of all current serotypes, while PCV20 covers just 52%.¹

“We see 50 is that age where we see that high risk,” Grubbs continued. “Patient walks in your pharmacy, they're healthy as a horse, they are 50 years of age, we vaccinate with Capvaxive (PCV21).”

While all vaccine recommendations for PCVs are significantly reliant on age, vaccination history, health conditions, and more, personalized approaches among each patient-pharmacist relationship are crucial for the promotion of pneumococcal immunization. Despite PCV20 being the better option in some situations, and vice versa, PCV21’s ability to protect against 32% more serotypes than PCV20 shows that the former is often the proper recommendation for the adult and at-risk populations.¹

“With every CDC recommendation, it is just a recommendation for the current. It's very interesting, [in] all 15 years of my career, I never understood the 5-year thing,” concluded Grubbs. “It actually makes sense. Every 5 years, we see that [serotype] shift, and you have to reevaluate. Do we need a new vaccine?”

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REFERENCE

1. Grubbs J. Recognizing and addressing the risks of shifting epidemiology of adult pneumococcal disease. Presented at: National Community Pharmacists Association 2025 Annual Convention & Expo; October 18-21, 2025; New Orleans, LA.

2. Chapter 17: pneumococcal disease. CDC. May 1, 2024. Accessed October 19, 2025. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-17-pneumococcal-disease.html

3. Types of pneumococcal vaccines. CDC. September 12, 2024. Accessed October 19, 2025. https://www.cdc.gov/pneumococcal/vaccines/types.html