Pneumococcal Vaccination Schedule for High-Risk Individuals
For high-risk individuals, the recommended pneumococcal vaccination schedule is either a single dose of PCV20 alone or a dose of PCV15 followed by PPSV23 at least 1 year later, according to the 2023 Advisory Committee on Immunization Practices (ACIP) guidelines. 1, 2
Vaccination Options for High-Risk Adults (19-64 years)
Option A: PCV20 Approach
- Administer a single dose of 20-valent pneumococcal conjugate vaccine (PCV20)
- No additional pneumococcal vaccines needed
Option B: PCV15 + PPSV23 Approach
- Administer a single dose of 15-valent pneumococcal conjugate vaccine (PCV15)
- Follow with 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year later
Special Considerations for Specific High-Risk Groups
Immunocompromised Adults
High-risk immunocompromised conditions include:
- Congenital or acquired asplenia
- Sickle cell disease/other hemoglobinopathies
- Chronic renal failure
- Congenital or acquired immunodeficiencies
- HIV infection
- Hematologic malignancies (leukemia, lymphoma, Hodgkin disease)
- Generalized malignancy
- Iatrogenic immunosuppression (including long-term corticosteroids)
- Multiple myeloma
- Nephrotic syndrome
- Solid organ transplant
For these patients, either vaccination approach is recommended:
Adults with Cochlear Implants or CSF Leaks
- Same schedule as immunocompromised patients
- Either PCV20 alone, or PCV15 followed by PPSV23 at least 8 weeks later 1
Hematopoietic Stem Cell Transplant Recipients
This group requires a more intensive vaccination schedule:
- Option A: Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT. Administer a fourth PCV20 dose ≥6 months after the third dose, or ≥12 months after HSCT, whichever is later.
- Option B: Administer 3 doses of PCV15, 4 weeks apart starting 3-6 months after HSCT, followed by PPSV23 ≥12 months after HSCT if no chronic GVHD. If patient has chronic GVHD, administer a fourth dose of PCV15 in place of PPSV23. 1
Revaccination Considerations
For Previously Vaccinated Individuals
- If previously received PPSV23 only: Administer a single dose of PCV20 or PCV15 at least 1 year after the last PPSV23 dose 2
- 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 2
- For adults ≥65 years who received PPSV23 before age 65: Administer one dose of PPSV23 at least 5 years after the previous PPSV23 dose 1
Timing Considerations
Optimal Timing
- When planning elective splenectomy or immunosuppressive therapy, complete pneumococcal vaccination at least 2 weeks before surgery or initiation of therapy 2
- For sequential vaccines (PCV15 followed by PPSV23), maintain minimum intervals:
Common Pitfalls and Caveats
Incorrect intervals between vaccines: Ensure proper timing between PCV and PPSV23, with appropriate intervals based on risk status (8 weeks for immunocompromised, 1 year for others) 2
Incomplete vaccination series: Complete the full recommended series for maximum protection, especially for HSCT recipients who require multiple doses 1
Uncertain vaccination history: When vaccination status is uncertain, proceed with recommended vaccination rather than missing an opportunity 2
Documentation errors: Clearly document which pneumococcal vaccines have been administered to guide future vaccination decisions 2
Missed high-risk individuals: Actively identify patients with chronic conditions who qualify for vaccination before age 65 2
The most recent evidence supports these recommendations, which aim to reduce morbidity and mortality from invasive pneumococcal disease in high-risk individuals through appropriate vaccination strategies.