From the Guidelines
The recommended pneumococcal vaccine regimen for adults is to receive one dose of PCV20 (Prevnar 20) alone, or one dose of PCV15 (Vaxneuvance) followed by a dose of PPSV23 (Pneumovax 23) at least one year later, depending on age and risk factors, as stated in the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) in 2023 1.
Key Considerations
- For adults 65 years and older, the current recommendation is to receive one dose of PCV20 alone, or one dose of PCV15 followed by a dose of PPSV23 at least one year later.
- For adults aged 19-64 with certain underlying medical conditions or risk factors, such as chronic heart, lung, or liver disease, diabetes, immunocompromising conditions, cochlear implants, or cerebrospinal fluid leaks, the same options apply: either one dose of PCV20 alone or PCV15 followed by PPSV23.
- Adults who have previously received PPSV23 but not a conjugate vaccine should receive a single dose of PCV20 or PCV15 at least one year after their last PPSV23 dose.
Rationale
These recommendations aim to provide optimal protection against pneumococcal disease by using conjugate vaccines (PCV15 or PCV20) which induce stronger immune memory and may provide longer-lasting protection than the polysaccharide vaccine (PPSV23) 1. The conjugate vaccines also help reduce nasopharyngeal carriage of pneumococcal bacteria, potentially decreasing transmission in the community.
Additional Guidance
- The ACIP recommends shared clinical decision-making for PCV13 use in adults aged ≥65 years who do not have an immunocompromising condition, CSF leak, or cochlear implant, and who have not previously received PCV13 1.
- For adults who have received both PCV13 and PPSV23, but have not yet received a final dose of PPSV23, the ACIP recommends completing the pneumococcal vaccine series with either a single dose of PCV20 or PPSV23 1.
Recent Updates
- The ACIP has updated its recommendations to include the use of PCV21, a 21-valent pneumococcal conjugate vaccine, for adults aged ≥19 years 1.
- The updated recommendations provide guidance on the use of PCV21, PCV20, and PCV15 in adults with various risk factors and medical conditions.
From the FDA Drug Label
The Advisory Committee on Immunization Practices (ACIP) has recommendations for revaccination against pneumococcal disease for persons at high risk who were previously vaccinated with PNEUMOVAX 23. The recommended pneumococcal vaccine regimen for adults is not explicitly stated in the provided drug label, but it mentions the use of PNEUMOVAX 23, a 23-valent pneumococcal polysaccharide vaccine. Key points:
- PNEUMOVAX 23 is a pneumococcal polysaccharide vaccine.
- The label does not provide a direct comparison between PCV and PPSV for adults.
- Revaccination with PNEUMOVAX 23 is recommended for persons at high risk who were previously vaccinated. 2
From the Research
Pneumococcal Vaccine Regimens for Adults
The recommended pneumococcal vaccine regimen for adults varies based on age and underlying health conditions.
- For adults aged ≥65 years, the 13-valent pneumococcal conjugate vaccine (PCV13) is recommended, as well as for immunocompromised adults aged <65 years 3.
- The Advisory Committee on Immunization Practices (ACIP) recommends a dose of PCV13 be followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in all adults aged ≥65 years who have not previously received pneumococcal vaccine and in persons aged ≥2 years who are at high risk for pneumococcal disease because of underlying medical conditions 4.
- As of 2024, the ACIP recommends a single dose of PCV for all PCV-naïve adults aged ≥50 years, with options including 20-valent PCV (PCV20), 21-valent PCV (PCV21), or 15-valent PCV (PCV15) in series with PPSV23 5.
Effectiveness of Pneumococcal Vaccination
Studies have evaluated the effectiveness of pneumococcal vaccination against pneumococcal pneumonia hospitalization in older adults.
- A prospective, test-negative study found that sequential PCV13/PPSV23 vaccination showed the highest adjusted vaccine effectiveness (VE) of 80.3% against pneumococcal community-acquired pneumonia (CAP) in adults aged 65-74 years, followed by single-dose PCV13 (adjusted VE, 66.4%) and PPSV23 (adjusted VE, 18.5%) 6.
- Another study found that PCV13 was effective in preventing vaccine-type community-acquired pneumonia, with an adequate safety profile when used in series with PPSV23 or compared to placebo 7.
Vaccine Recommendations
The ACIP recommendations for pneumococcal vaccination in adults are based on the individual's age and risk factors for pneumococcal disease.
- Adults aged ≥50 years who are PCV-naïve should receive a single dose of PCV, with options including PCV20, PCV21, or PCV15 in series with PPSV23 5.
- Immunocompromised adults aged <65 years should receive PCV13, as well as adults aged ≥65 years who have not previously received pneumococcal vaccine 3, 4.