Are patients who previously received Pneumovax (Pneumococcal Polysaccharide Vaccine) eligible for a booster dose with Prevnar (Pneumococcal Conjugate Vaccine, PCV13)?

Pneumococcal Vaccination for Patients Previously Vaccinated with Pneumovax

Yes, patients who previously received Pneumovax (PPSV23) are eligible for a booster dose with Prevnar (PCV13/PCV15/PCV20), with PCV20 being the preferred option administered at least 1 year after the previous PPSV23 dose. 1

Current Recommendations Based on Prior Vaccination Status

For Adults Previously Vaccinated with PPSV23 Only:

• Administer a single dose of PCV20 (preferred) or PCV15 at least 1 year after the most recent PPSV23 dose 1
• If PCV15 is used instead of PCV20, no additional PPSV23 dose is needed 1
• This recommendation applies to both immunocompetent and immunocompromised adults 1

For Adults Who Previously Received PCV13 Only:

• Complete the series with either PCV20 or PPSV23 with an interval of ≥1 year after the PCV13 dose 1
• For immunocompromised patients, the minimum interval between PCV13 and PPSV23 can be shortened to 8 weeks 1, 2
• PCV20 offers broader serotype coverage and may be preferable to PPSV23 for completing the series 1

For Adults Who Received Both PCV13 and PPSV23 Previously:

• If they haven't received their final recommended dose, they can receive either PCV20 or PPSV23 1
• If PCV20 is selected, administer it ≥5 years after the last pneumococcal vaccine dose 1
• If PPSV23 is selected, administer it ≥1 year after PCV13 (or ≥8 weeks for immunocompromised patients) and ≥5 years after previous PPSV23 1

Special Considerations

For Immunocompromised Patients:

• HIV-infected adults should receive one dose of PCV20 alone, or PCV15 followed by PPSV23 at least 8 weeks later 2
• Cancer patients should receive PCV20 (preferred) or PCV15 followed by PPSV23 at least 8 weeks later 1
• For patients with functional or anatomic asplenia, vaccination is particularly important, with PCV20 being the preferred option 1

Timing Considerations:

• Prior PPSV23 vaccination may diminish the immune response to subsequent PCV20 administration 3, 4
• Despite this potential blunting effect, the additional protection from broader serotype coverage justifies administering PCV20 after PPSV23 1, 4
• The minimum interval of 1 year between PPSV23 and subsequent PCV administration helps optimize the immune response 1, 3

Clinical Benefits and Rationale

• PCV vaccines (PCV13/PCV15/PCV20) offer immunologic advantages over PPSV23, including stronger and potentially more durable immune responses 1
• Clinical studies have demonstrated that PCV13 is effective in preventing vaccine-type pneumococcal community-acquired pneumonia and invasive pneumococcal disease in adults 5
• For immunocompromised patients, adding PCV vaccination after previous PPSV23 vaccination can be cost-effective and potentially reduce both disease burden and healthcare costs 6
• PCV20 provides the broadest serotype coverage among available conjugate vaccines and eliminates the need for sequential vaccination with PPSV23 1

Common Pitfalls to Avoid

1. Incorrect timing: Administering PCV too soon after PPSV23 (less than 1 year) may result in a suboptimal immune response 3
2. Overlooking immunocompromised status: The interval between vaccines can be shortened to 8 weeks for immunocompromised patients 1, 2
3. Failing to recognize the value of PCV20: When available, PCV20 is now preferred over the PCV15+PPSV23 sequence due to broader coverage in a single dose 1
4. Assuming revaccination is unnecessary: Even patients who completed their recommended pneumococcal vaccination series may benefit from PCV20 vaccination, especially if they are at high risk for pneumococcal disease 1

By following these updated recommendations, clinicians can ensure optimal protection against pneumococcal disease for patients previously vaccinated with Pneumovax.