From the Guidelines
The pneumonia vaccine protocol for adults should follow the latest recommendations from the Advisory Committee on Immunization Practices, which suggests using PCV21, PCV20, or PCV15 for adults aged ≥19 years, with specific schedules depending on the individual's risk factors and previous vaccine history, as outlined in the 2024 guidelines 1.
Key Recommendations
- For adults 65 years and older, a single dose of PCV21, PCV20, or PCV15 is recommended, with PCV15 followed by a dose of PPSV23 at least 1 year later if PCV15 is used.
- For adults 19-64 years with an immunocompromising condition, a single dose of PCV21, PCV20, or PCV15 is recommended, with PCV15 followed by a dose of PPSV23 at least 8 weeks later if PCV15 is used.
- For adults 19-64 years with chronic medical conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with PCV15 followed by a dose of PPSV23 at least 1 year later if PCV15 is used.
Vaccine Options
- PCV21: a 21-valent pneumococcal conjugate vaccine
- PCV20: a 20-valent pneumococcal conjugate vaccine
- PCV15: a 15-valent pneumococcal conjugate vaccine
- PPSV23: a 23-valent pneumococcal polysaccharide vaccine
Previous Guidelines
Previous guidelines, such as those from 2023 1 and 2019 1, recommended different vaccine schedules and options, but the latest guidelines from 2024 should be followed for the most up-to-date recommendations.
Risk Factors
- Immunocompromising conditions, such as chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, HIV infection, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplant, congenital or acquired asplenia, or sickle cell disease or other hemoglobinopathies
- Chronic medical conditions, such as alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, or diabetes mellitus
- CSF leak or cochlear implant
From the Research
Pneumonia Vaccine Protocol for Adults
- The pneumonia vaccine protocol for adults involves the use of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2.
- The Advisory Committee on Immunization Practices (ACIP) recommends routine use of PCV13 for adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants, in addition to PPSV23 2.
- For adults 65 years of age or older, PCV13 has been shown to be 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 3.
- The use of PCV13 in series with PPSV23 has been evaluated in several studies, with results showing improved immune response and adequate safety profiles 4, 5.
- The safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV15) has also been evaluated in adults ≥65 years of age, with results showing comparable safety profiles to PCV13 and high levels of IgG and OPA antibodies to all 15 serotypes included in the vaccine 4.
Vaccine Administration
- PCV13 should be administered to eligible adults in addition to PPSV23, with a minimum interval of 1 year between vaccinations 2.
- The administration of pneumococcal polysaccharide vaccine or pneumococcal conjugate vaccine within three years following receipt of PPSV23 has been associated with increased reactogenicity and reduced antibody titers 4.
- The optimal timing and sequence of PCV13 and PPSV23 administration are still being evaluated, with ongoing studies aiming to determine the most effective vaccination strategy for adults 5, 3.