What is the recommended vaccination schedule for preventing pneumococcal disease, specifically pneumonia?

Pneumococcal Vaccination Recommendations

For adults aged ≥65 years and adults aged 19-64 years with certain underlying conditions, a single dose of PCV20 alone or PCV15 followed by PPSV23 is recommended for prevention of pneumococcal disease. 1

Adult Vaccination Recommendations

Adults aged ≥65 years:

• Option A: Single dose of PCV20
• Option B: Single dose of PCV15, followed by PPSV23 at least 1 year later

Adults aged 19-64 years with risk conditions:

Risk conditions include:

• Chronic medical conditions (alcoholism, chronic heart/liver/lung disease, diabetes)
• Immunocompromising conditions (HIV, cancer, immunosuppressive therapy)
• Anatomic or functional asplenia
• Cerebrospinal fluid leaks
• Cochlear implants

Recommended schedule:

• Option A: Single dose of PCV20
• Option B: Single dose of PCV15, followed by PPSV23 at least 1 year later

For adults with previous pneumococcal vaccination:

If previously received PPSV23 only:

• Administer a single dose of PCV20 or PCV15 at least 1 year after the last PPSV23 dose

If previously received PCV13 only:

• Administer a single dose of PCV20 at least 1 year after PCV13, or
• Administer PPSV23 at least 1 year after PCV13

If previously received both PCV13 and PPSV23:

• No additional doses needed until age 65, then reassess

Special Populations

Hematopoietic Stem Cell Transplant Recipients (≥19 years):

• Option A: 3 doses of PCV20, 4 weeks apart starting 3-6 months after transplant, with a fourth dose ≥6 months after the third dose
• Option B: 3 doses of PCV15, 4 weeks apart starting 3-6 months after transplant, followed by PPSV23 ≥12 months after transplant (if no chronic GVHD)

Pediatric Vaccination Schedule

• Routine schedule: PCV at 2,4,6, and 12-15 months of age
• High-risk children aged 2-18 years: Should receive PPSV23 after completing all recommended doses of PCV, at least 8 weeks after the most recent PCV dose

Clinical Considerations

• Pneumococcal vaccines are critical for reducing morbidity and mortality from invasive pneumococcal disease
• The 2023 ACIP recommendations significantly simplified the previous complex pneumococcal vaccination schedule
• For adults with uncertain vaccination history, providers should not withhold vaccination and may administer according to the current recommendations 2
• When planning elective splenectomy or immunosuppressive therapy, pneumococcal vaccination should be completed at least 2 weeks before surgery or initiation of therapy 1

Common Pitfalls to Avoid

1. Incorrect intervals between vaccines: Ensure proper timing between PCV and PPSV23 (minimum 1 year interval for adults)
2. Missing high-risk individuals: Actively identify patients with chronic conditions who qualify for vaccination before age 65
3. Withholding vaccination due to unknown history: When vaccination status is uncertain, proceed with recommended vaccination
4. Inadequate documentation: Clearly document which pneumococcal vaccines have been administered to guide future vaccination decisions

The current recommendations represent a significant simplification from previous guidelines, making implementation more straightforward while maintaining protection against pneumococcal disease.