What are the vaccination guidelines for Streptococcal (Streptococcus) pneumoniae pneumonia?

From the Guidelines

Pneumococcal vaccination is recommended for all adults aged 65 and older, as well as for younger individuals with certain risk factors, with PCV21 being the preferred vaccine according to the most recent guidelines 1.

Key Recommendations

• The current guidelines recommend PCV21 (21-valent pneumococcal conjugate vaccine) as the primary pneumococcal vaccine for adults aged 65 and older, as well as for younger individuals with certain risk factors 1.
• For those who have not received any pneumococcal vaccine, a single dose of PCV21 is recommended 1.
• For those who have received PCV15, a follow-up dose of PPSV23 should be given at least one year later to provide broader protection, but PCV21 can be used as an alternative if PPSV23 is not available 1.
• High-risk individuals who should receive vaccination before age 65 include those with:
  • Chronic heart, lung, or liver disease
  • Diabetes
  • Alcoholism
  • Cigarette smokers
  • Weakened immune systems due to conditions like HIV, cancer, or immunosuppressive medications

Vaccination Schedule

• The timing between doses varies based on risk factors, with immunocompromised patients needing a shorter interval of 8 weeks between PCV15 and PPSV23 1.
• For adults aged 19-64 years with an immunocompromising condition, a CSF leak, or a cochlear implant, a single dose of PCV21, PCV20, or PCV15 is recommended, with a follow-up dose of PPSV23 given at least 8 weeks later if PCV15 is used 1.

Benefits of Vaccination

• Vaccination significantly reduces the risk of invasive pneumococcal disease, including bacteremia and meningitis, which carry high mortality rates, especially in elderly and immunocompromised populations 1.
• The vaccines work by stimulating the immune system to produce antibodies against the polysaccharide capsule of Streptococcus pneumoniae bacteria, which is responsible for most cases of bacterial pneumonia.

From the FDA Drug Label

Prevnar 20 is a vaccine indicated for • active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older. • active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 18 years of age and older.

The bacterial pneumonia vaccination guidelines for Prevnar 20 are as follows:

• Children: Administer Prevnar 20 as a 4-dose immunization series at 2,4,6, and 12 through 15 months of age.
• Adults: Administer Prevnar 20 as a single dose in adults 18 years of age and older. 2

From the Research

Bacterial Pneumonia Vaccination Guidelines

• The pneumococcal polysaccharide vaccine (PPV23) has a clinical effectiveness of 43-81% in older adults, with antibody responses lasting 5-10 years 3.
• The use of pneumococcal conjugate vaccines (PCVs) has led to a dramatic fall in the incidence of conjugate vaccine-type invasive pneumococcal disease in children, and this has also reduced the incidence of conjugate vaccine-serotype disease in older adults 3.
• National guidelines have been updated to incorporate new pneumococcal vaccines, such as PCV15 and PCV20, into clinical practice, providing an opportunity to use conjugated vaccines against a wider spectrum of pneumococcal serotypes 4, 5.
• The immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been investigated in people living with HIV, with results showing that only a minority of individuals achieved seroprotection after vaccination, and protective immunity waned rapidly 6.
• The introduction of new-generation pneumococcal vaccines with expanded serotype coverage has reshaped pneumococcal immunization strategies, particularly in adults, replacing previous sequential vaccine recommendations in many settings 5.
• Despite the success of pneumococcal conjugate vaccines, some weaknesses have been identified, including challenges associated with certain serotypes, such as Streptococcus pneumoniae type 3, which remains a major cause of invasive pneumococcal disease in several countries 7.

Vaccination Strategies

• Utilizing both conjugate and purified polysaccharide modalities in series has produced greater and lasting immunity 4.
• The development of higher-valent pneumococcal vaccines, such as PCV15 and PCV20, provides an opportunity to use conjugated vaccines against a wider spectrum of pneumococcal serotypes 4, 5.
• Co-administration of the diphtheria-tetanus-polio (DTP) vaccine may augment pneumococcal vaccination responses 6.
• Further research into alternative vaccination strategies for people living with HIV is needed, such as vaccination schedules with higher-valent pneumococcal vaccines 6.

Future Directions

• Adult pneumococcal vaccination recommendations are continuously evolving to enhance protection in high-risk populations and optimize long-term immunity 5.
• Emerging epidemiological data and shifts in pneumococcal serotype distribution continue to influence vaccine policy decisions and immunization guidelines worldwide 5.
• Novel vaccination approaches, such as the use of new-generation pneumococcal vaccines, may have a significant impact on public health outcomes 5.