What are the guidelines for Pneumococcal (PCV) vaccine administration?

From the Guidelines

Adults aged 65 and older should receive a single dose of PCV21, PCV20, or PCV15, and if PCV15 is administered, a single dose of PPSV23 should be administered ≥1 year after the PCV15 dose, as recommended by the Advisory Committee on Immunization Practices in 2024 1. The pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are crucial in preventing serious respiratory infections caused by Streptococcus pneumoniae bacteria. Key points to consider for vaccination schedules include:

• Adults aged ≥65 years:
  • If no previous vaccination or only PCV7, administer a single dose of PCV21, PCV20, or PCV15, and if PCV15 is used, administer PPSV23 ≥1 year later.
  • If previously vaccinated with PPSV23, administer a single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose.
• Adults aged 19-64 years with immunocompromising conditions, CSF leaks, or cochlear implants:
  • If no previous vaccination or only PCV7, administer a single dose of PCV21, PCV20, or PCV15, and if PCV15 is used, administer PPSV23 ≥8 weeks later.
  • If previously vaccinated with PPSV23, administer a single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose.
• Adults aged 19-64 years with chronic medical conditions:
  • If no previous vaccination or only PCV7, administer a single dose of PCV21, PCV20, or PCV15, and if PCV15 is used, administer PPSV23 ≥1 year later.
  • If previously vaccinated with PPSV23, administer a single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose. These recommendations are based on the most recent guidelines from the Advisory Committee on Immunization Practices in 2024 1, which prioritize the use of PCV21, PCV20, or PCV15 for adults aged ≥65 years and those with certain medical conditions. It is essential to note that the vaccination schedule may vary depending on the individual's medical history and previous vaccinations, and healthcare providers should consult the latest guidelines and consider shared clinical decision-making when necessary 1.

From the Research

Pneumonia Vaccine Guidelines

• The recommended vaccination schedule for the pneumococcal conjugate vaccine (PCV) includes 4 immunizations, according to the national programs in the United States and some European countries 2.
• Other countries use a national schedule for routine vaccinations in early childhood that includes only 3 doses 2.
• A study found that two doses of PCV induced satisfactory antibody responses, with the exception of serotypes 6B and 23F, and the third dose evoked strong responses for all serotypes 2.
• The 13-valent pneumococcal conjugate vaccine (PCV13) is effective in preventing vaccine-type pneumococcal community-acquired pneumonia in adults 65 years of age or older 3, 4.
• The combination of PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPSV23) is superior to PPSV23 alone for reducing incidence or severity of pneumonia in older adults 3.
• The Advisory Committee on Immunization Practices (ACIP) recommends the use of 15-valent pneumococcal conjugate vaccine (PCV15) as an option for pneumococcal conjugate vaccination of persons aged <19 years according to currently recommended PCV13 dosing and schedules 5.

Vaccine Types and Recommendations

• There are two leading vaccines targeted against S. pneumoniae: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) 3, 6.
• PCV13 contains the seven serotypes in PCV7, five additional serotypes from PPSV23, and a new serotype not contained in PPSV23 or PCV7 6.
• PCV15 contains serotypes 22F and 33F (in addition to the PCV13 serotypes) conjugated to CRM197 (genetically detoxified diphtheria toxin) 5.
• Risk-based recommendations on use of PPSV23 for persons aged 2-18 years with certain underlying medical conditions that increase the risk for pneumococcal disease have not changed 5.

Efficacy and Safety

• PCV13 was effective in preventing first episodes of vaccine-type strains of pneumococcal community-acquired pneumonia, nonbacteremic and noninvasive pneumococcal community-acquired pneumonia, and invasive pneumococcal disease in adults 65 years of age or older 4.
• The efficacy of PCV13 persisted throughout the trial (mean follow-up, 3.97 years) 4.
• PCV15 was found to be safe and effective in preventing vaccine-type pneumococcal disease in children and adults 5.