What is the recommended pneumonia vaccine regimen for adults and children?

Pneumococcal Vaccination Recommendations for Adults and Children

For adults aged ≥65 years and adults aged 19-64 years with certain medical conditions, a single dose of PCV20 alone or PCV15 followed by PPSV23 is recommended as the preferred pneumococcal vaccination regimen. 1, 2

Adult Pneumococcal Vaccination Recommendations

For Adults Aged ≥65 Years:

• Option A (preferred): Single dose of PCV20
• Option B: Single dose of PCV15, followed by PPSV23 ≥1 year later

For Adults Aged 19-64 Years with Risk Factors:

Adults with these conditions should receive pneumococcal vaccination:

• Chronic medical conditions (heart disease, lung disease, liver disease, diabetes)
• Alcoholism
• Cigarette smoking
• Immunocompromising conditions (including HIV, malignancy, immunodeficiency)
• Cerebrospinal fluid leak or cochlear implant
• Functional or anatomic asplenia
• Chronic renal failure or nephrotic syndrome

Vaccination Schedule for Adults with Risk Factors:

• For immunocompetent adults with chronic conditions:

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

• For immunocompromised adults:

  • Option A: Single dose of PCV20
  • Option B: Single dose of PCV15, followed by PPSV23 ≥8 weeks later

For Previously Vaccinated Adults:

1. If previously received PPSV23 only:

   • Administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose

2. If previously received PCV13 only:

   • Administer PCV20 ≥1 year after PCV13, OR
   • Administer PPSV23 ≥1 year after PCV13 (≥8 weeks for immunocompromised)

3. If previously received both PCV13 and PPSV23:

   • For adults ≥65 years: Shared clinical decision-making regarding additional PCV20 dose
   • For adults 19-64 years with immunocompromising conditions: Consider PCV20 or additional PPSV23 dose ≥5 years after last pneumococcal vaccine

Pediatric Pneumococcal Vaccination Recommendations

• Children <2 years: Routine series of PCV13, PCV15, or PCV20 according to age-appropriate schedule
• Children 2-18 years with risk factors: PCV13/PCV15/PCV20 followed by PPSV23
• PPSV23 is not approved for use in children <2 years as they don't develop effective immune response to polysaccharide vaccines 3

Common Pitfalls and Caveats

1. Timing between vaccines matters:

   • For immunocompromised adults: Minimum 8-week interval between PCV15 and PPSV23
   • For immunocompetent adults: Minimum 1-year interval between PCV15 and PPSV23

2. Revaccination considerations:

   • Routine revaccination of immunocompetent persons previously vaccinated with PPSV23 is not recommended 3
   • Elderly individuals may experience more adverse reactions with revaccination

3. Special populations:

   • Hematopoietic stem cell transplant recipients require specialized vaccination schedules 2
   • Pregnant women: Limited data available, but pneumococcal vaccines can be given if indicated 3

4. Concomitant administration:

   • Consider separating pneumococcal vaccines and Zostavax by at least 4 weeks due to reduced immune response when given concurrently 3

The 2023 ACIP recommendations represent a significant update from previous guidelines, moving away from the routine PCV13+PPSV23 series for all adults ≥65 years to preferring either PCV20 alone or PCV15 followed by PPSV23. This change reflects the reduced burden of PCV13 serotypes due to indirect effects from pediatric vaccination programs and the availability of newer conjugate vaccines covering more serotypes 1, 2.