Systems Biology of PNEUMOVAX®23 and PREVNAR 13®

RATIONALE: PCV13 [13-valent pneumococcal conjugate vaccine (Prevnar®13)] induces better
functional immune responses when compared to PPV23 [23-valent pneumococcal polysaccharide
vaccine (Pneumovax®23)] in older naïve adults. We hypothesize that this is due to intrinsic
defects in innate responses that could explain the poor immunogenicity of PPV23 when compared
to PCV13. Therefore, we propose to extensively study innate and adaptive immune responses
generated after administration of either pneumococcal polysaccharide or conjugate vaccines in
older adults.

STUDY DESIGN: Single center, open label study in which adult healthy volunteers will be
vaccinated with either PPV23 or PCV13. Blood samples will be collected on Days D0 (at
enrollment) and D1, D3, D7, D14, D30 and D180 post vaccination to study innate and adaptive
immune responses.

Even though PPV23 and PCV13 are considered safe, volunteers will be asked to report any local
or systemic AEs from Day 0 (vaccination) to Day 7 . Reactogenicity events will also be
evaluated by injection site examination on visits at D0, D1, D3 and D7. Also volunteers are
asked to report any local or systemic AEs for 30 days post vaccination and any SAEs for 180
days post vaccination. Volunteers are also asked to report local and systemic AEs developing
the day of a blood draw.

Inclusion Criteria:

1. Able to understand and give informed consent.

2. Immunocompetent community dwelling subjects between the ages of ages of 25-40 and
60-89 years.

Exclusion Criteria:

1. Prior vaccination with pneumococcal vaccine.

2. Receipt of any of the following products:

1. Blood products within 3 months prior to study entry or expected receipt at any
time after study entry*.

2. Any live virus vaccines within 4 weeks prior to study entry or expected receipt
within 4 weeks after study entry*.

3. Any inactivated vaccine within 2 weeks or expected receipt within 2 weeks after
study entry*.

3. Presence of co-morbidities or immunosuppressive states such as:

- Chronic medical problems including (but not limited to) insulin dependent
diabetes, severe heart disease, severe lung disease, severe liver disease,
cerebrospinal fluid leaks, severe kidney disease, autoimmune diseases, severe
gastrointestinal diseases and grade 4 hypertension per CTCAE criteria** .

- Alcohol, drug abuse or psychiatric conditions that in the opinion of the
investigator would preclude compliance with the trial or interpretation of safety
or endpoint data.

- Impaired immune function or known chronic infections including, but not limited,
to known HIV, hepatitis B or C; organ transplant; immunosuppression due to
cancer; current and/or expected receipt of chemotherapy, radiation therapy,
steroids*** (i.e., more than 20 mg of prednisone given daily or on alternative
days for 2 weeks or more in the past 90 days , or high dose inhaled
corticosteroids**** or any other immunosuppressive therapies (including anti-TNF
therapy), functional or anatomic asplenia and congenital immunodeficiency.

4. Conditions that could affect the safety of the volunteers such as:

o Severe reactions to prior vaccinations.

o An allergy to any component of the study vaccines (phenol, aluminum, CRM197 protein,
succinic acid, Polysorbate 80).

- History of Guillain-Barré syndrome.

- History of bleeding disorders.

5. Volunteers with any acute illness* including, but not limited to, - fever (> 100.4 F
[> 38 C], regardless of the route) within 3 days prior to study entry.

6. Volunteers with social conditions or occupational conditions or any condition that in
the opinion of the investigator might interfere with compliance with the study and
vaccine evaluation.

7. Pregnant or breast feeding or women expected to conceive within 30 days after
vaccination *****

- An individual who initially is excluded from study participation based on one or
more of the time-limited exclusion criteria (e.g., acute illness, receipt or
expected receipt of live or inactivated vaccines ) may be reconsidered for
enrollment once the condition has resolved as long as the subject continues to
meet all other entry criteria.

- Grade 4 hypertension per CTCAE criteria is defined as Life threatening
consequences(e.g., malignant hypertension, transient or permanent neurologic
deficit, hypertensive crisis) urgent intervention indicated. ***Subjects
receiving > 20 mg/day of prednisone or its equivalent daily or on alternate
days for more than 2 weeks may enter the study after therapy has been
discontinued for more than 3 months.

- High dose ICS is defined as: > 960 mcg/day of beclomethasone
dipropionate or equivalent ***** Women of child-bearing potential (not
surgically sterile via tubal ligation, bilateral oophorectomy or
hysterectomy or who are not postmenopausal for ≥1 year) must agree to
practice adequate contraception that may include, but is not limited
to, abstinence, monogamous relationship with vasectomized partner,
barrier methods such as condoms, diaphragms, spermicides, intrauterine
devices, and licensed hormonal methods for 30 days before and 30 days
after receiving PPV23 or PCV13.