Is a booster dose of Pneumovax23 (Pneumococcal Polysaccharide Vaccine) recommended for a 71-year-old female who received Prevnar13 (Pneumococcal Conjugate Vaccine) 6 years ago and Pneumovax23 13 years ago?

From the Guidelines

A booster dose of Pneumovax23 (PPSV23) is recommended for this 71-year-old female. Since she received her first Pneumovax23 dose 13 years ago and her Prevnar13 (PCV13) 6 years ago, she is due for a PPSV23 booster. According to the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) in 2023 1, for adults 65 years and older who have received both PCV13 and PPSV23 but have not yet received a final dose of PPSV23 at age ≥65 years, a single dose of PPSV23 is recommended to complete their pneumococcal vaccine series. The recommended interval between PCV13 and PPSV23 is at least 1 year, which has been well exceeded in this case. This booster is important because immunity from pneumococcal vaccines wanes over time, particularly in older adults, and the risk of invasive pneumococcal disease increases with age. The booster helps maintain protection against the 23 pneumococcal serotypes covered by Pneumovax23.

Key points to consider:

• The patient's age and previous vaccination history make her eligible for a PPSV23 booster.
• The ACIP recommends a single dose of PPSV23 for adults aged ≥65 years who have received both PCV13 and PPSV23 but have not yet received a final dose of PPSV23 at age ≥65 years.
• The vaccine is generally well-tolerated, though some patients may experience mild side effects such as soreness at the injection site, low-grade fever, or muscle aches for 1-2 days after vaccination, as noted in previous guidelines 1.
• The most recent guidelines from 2023 1 support the recommendation for a PPSV23 booster in this patient, prioritizing her morbidity, mortality, and quality of life outcomes.

From the Research

Pneumococcal Vaccination Recommendations

• The Advisory Committee on Immunization Practices (ACIP) recommends that adults aged 65 years and older who have not previously received pneumococcal vaccine should receive a dose of PCV13 followed by a dose of PPSV23 2.
• For adults who have previously received PPSV23, the ACIP recommends a dose of PCV13, but the timing of this dose depends on the age and risk group of the individual 2.

Booster Dose Recommendations

• There is limited evidence on the need for a booster dose of PPSV23 in adults who have previously received PCV13 and PPSV23 3.
• One study found that revaccination with PPSV23 was well tolerated, but the evidence on multiple revaccinations was limited and mixed 3.
• Another study found that a second PCV13 given about 4 years after a first vaccination induced higher anti-pneumococcal opsonophagocytic activity (OPA) titers than the initial vaccination for some serotypes, but the responses to subsequent PPSV23 administration were generally lower 4.

Specific Considerations for the 71-year-old Female

• Given that the individual received Prevnar13 (PCV13) 6 years ago and Pneumovax23 (PPSV23) 13 years ago, the need for a booster dose of PPSV23 is uncertain 3.
• The ACIP recommendations do not provide clear guidance on the timing of a booster dose of PPSV23 in this scenario, and the evidence from studies is limited 2, 3.
• However, one study found that initial vaccination with PCV13 establishes an immune state that results in recall anti-pneumococcal responses upon subsequent vaccination with either conjugated or free polysaccharide vaccine 4.