From the Guidelines
Pneumonia vaccine guidelines recommend that adults aged 65 and older should receive one dose of PCV15 or PCV20, and if PCV15 is used, it should be followed by a dose of PPSV23 at least one year later. For adults 19-64 with certain medical conditions, such as chronic heart, lung, or liver disease, diabetes, alcoholism, or immunocompromising conditions, vaccination is also recommended, typically starting with PCV15 or PCV20 1. The timing between doses varies based on risk factors, with immunocompromised patients needing shorter intervals (8 weeks) between PCV15 and PPSV23 1.
Key Recommendations
- Adults aged 65 and older should receive one dose of PCV15 or PCV20 1.
- If PCV15 is used, it should be followed by a dose of PPSV23 at least one year later 1.
- For adults 19-64 with certain medical conditions, vaccination is recommended, typically starting with PCV15 or PCV20 1.
- Immunocompromised patients need shorter intervals (8 weeks) between PCV15 and PPSV23 1.
Vaccine Options
- PCV15: a 15-valent pneumococcal conjugate vaccine 1.
- PCV20: a 20-valent pneumococcal conjugate vaccine 1.
- PPSV23: a 23-valent pneumococcal polysaccharide vaccine 1.
Side Effects
- Side effects are generally mild and include soreness at the injection site, fatigue, and low-grade fever that typically resolve within 48 hours 1.
Immune Response
- The conjugate vaccines (PCV series) provide longer-lasting immunity by engaging T-cells in the immune response, while PPSV23 covers more bacterial strains 1.
Special Considerations
- Hematopoietic stem cell transplant recipients have specific vaccination schedules, including the use of PCV20 or PCV15 and PPSV23 1.
- Shared clinical decision-making is recommended for adults aged 65 and older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant, and who have not previously received PCV13 1.
From the Research
Pneumonia Vaccine Guidelines
- The Advisory Committee on Immunization Practices (ACIP) recommends routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2.
- PCV13 was approved by the Food and Drug Administration (FDA) in late 2011 for use among adults aged ≥50 years 2.
- A randomized placebo-controlled trial evaluating efficacy of PCV13 for preventing community-acquired pneumonia among approximately 85,000 adults aged ≥65 years with no prior pneumococcal vaccination history (CAPiTA trial) showed moderate level of evidence supporting PCV13 vaccination of adults 2.
Effectiveness of Pneumococcal Vaccines
- The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia, and can lower the burden of vaccine-type pneumococcal pneumonia 3.
- PPSV23-conferred protection may be lower in adults aged ≥75 years, those with certain underlying conditions, and individuals who were vaccinated >5 years before disease onset 3.
- PCV13 induces a greater functional immune response than PPSV23 for the majority of serotypes covered by PCV13, suggesting that PCV13 could offer immunological advantages over PPSV23 for prevention of vaccine-type pneumococcal infection 4.
Updated Recommendations
- The ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years in 2024 5.
- Recommendations for PCVs among adults aged 19-49 years with risk conditions and PCV13-vaccinated adults have not changed from previous recommendations 5.
- The use of PCV13 in series with PPSV23 has been shown to be safe and effective in preventing vaccine-type community-acquired pneumonia in older adults 6.