Gocovri
Gocovri
Generic Name
Gocovri
Mechanism
Gocovri encodes capsular polysaccharide antigens from 13 *Streptococcus pneumoniae* serotypes conjugated to the CRM197 carrier protein.
• Conjugation activates T‑cell–dependent pathways, generating robust IgG and memory B‑cell responses.
• Resulting antibodies opsonize bacteria for phagocytosis and facilitate clearance, providing both immediate and long‑term protection.
Pharmacokinetics
| Parameter | Comment |
| Absorption | Intramuscular injection; antigen is displayed at the injection site, encountered by antigen‑presenting cells. |
| Distribution | Antigen–protein complex remains largely localized; systemic immune response forms. |
| Metabolism | Protein‑carrier and polysaccharide components are degraded by proteases and glycosidases. |
| Elimination | Metabolites cleared via lymphatics and renal excretion; no active drug remains. |
| Onset of Immunogenicity | Serotype‑specific IgG detectable within 2–4 weeks; protective titers plateau after ~6 weeks. |
Indications
- Prevention of IPD (including meningitis, bacteremia, and pneumococcal pneumonia).
- Adults ≥ 65 yrs or ≥ 19 yrs with:
- Chronic heart, lung, liver, or kidney disease.
- Diabetes mellitus.
- Immune compromise (HIV, solid‑organ transplant, chemotherapy, immunosuppressive drugs).
- Cochlear implant, cerebrospinal fluid leak, or sickle cell disease.
- Recommended following pneumococcal polysaccharide vaccine (PPSV23) when indicated for additional protection.
Contraindications
- Severe, life‑threatening allergy to any vaccine component.
- Active febrile illness requiring hospitalization.
- Pregnancy: not specifically contraindicated, but not studied in pregnancy; use only when clearly needed.
- G6PD deficiency: no data suggesting risk, but monitor as with other vaccines.
- Warn: Potential for local injection-site reactions, fever, headache, and malaise; allergic reactions may occur in severely immunocompromised patients.
Dosing
| Age / Risk Group | Dose | Administration | Schedule |
| Adults ≥ 65 yrs | 15 mg (2 mL) | Injection into the deltoid muscle | Single dose |
| High‑risk adults ≥ 19 yrs | 15 mg (2 mL) | Deltoid intramuscular | Single dose |
| Follow‑up | If previously received PPSV23, give Gocovri ≥ 8 weeks after PPSV23. |
• Use a clean syringe and needle.
• Rotate sites if multiple doses are needed in different patient groups.
Adverse Effects
- Common (≤ 10 %)
- Injection‑site redness, swelling, and pain.
- Fever, headache, fatigue, myalgia.
- Serious (≤ 1 %)
- Severe allergic reaction (anaphylaxis).
- Unexplained severe fever, shock, or organ‑specific complications should prompt evaluation.
Monitoring
- Post‑vaccination observation: 15–30 min for anaphylaxis.
- Clinical follow‑up: Check for IPD signs in high‑risk patients for 6 weeks.
- Serologic response: Not routinely performed, but may be considered in immunocompromised patients to confirm seroconversion.
Clinical Pearls
- Why conjugate? Gocovri’s CRM197 carrier stimulates a T‑cell help, improving efficacy in older and immunocompromised patients compared to polysaccharide‑only vaccines.
- PPSV23 vs. Gocovri: PPSV23 covers 23 serotypes but elicits a short‑lasting, T‑cell–independent response; Gocovri’s 13 serotypes are part of PPSV23 but provide stronger, durable immunity.
- Vaccination timing: If a patient has received PPSV23 within the past 8 weeks, wait ≥ 8 weeks before administering Gocovri to avoid antigenic interference.
- High‑risk priority: For adults with cochlear implants, cystic fibrosis, or chronic lung disease, give Gocovri first; it offers protective coverage against the most common IPD serotypes in these populations.
- Documentation: Record the vaccine lot number and administration date; this aids in outbreak investigations and tracking vaccine efficacy.
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• Key Takeaway: *Gocovri* is the frontline conjugate pneumococcal vaccine for adults at elevated risk of invasive disease. Its conjugated design ensures robust, long‑lasting immunity and is especially vital for older adults and those with chronic illnesses or immune suppression.