From the Guidelines
No, pneumonia should not be assessed to determine the needed Pneumococcal Conjugate Vaccine (PCV), as the choice of PCV is based on the patient's age, medical conditions, and vaccination history. The most recent and highest quality study, published in 2024 1, provides guidance on the use of 21-valent pneumococcal conjugate vaccine among U.S. adults. According to this study, the recommendation for which specific PCV vaccine to administer is based on current immunization guidelines, the patient's risk factors for pneumococcal disease, and their previous vaccination status.
Key Considerations
- The patient's age is a crucial factor in determining the type of PCV to be administered, with different recommendations for adults aged 19-64 years and those aged 65 years and older.
- Certain medical conditions, such as immunocompromising conditions, chronic heart disease, and chronic lung disease, also play a role in determining the type of PCV to be administered.
- The patient's vaccination history, including previous receipt of PCV or PPSV23, is also an important consideration in determining the type of PCV to be administered.
Recommendations
- For adults aged 65 years and older, a single dose of PCV21, PCV20, or PCV15 is recommended, with a minimum interval of 8 weeks considered for dosing of PCV15 and PPSV23 in certain cases 1.
- For adults with immunocompromising conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with a minimum interval of 8 weeks considered for dosing of PCV15 and PPSV23 in certain cases 1.
- For adults with chronic medical conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with a minimum interval of 1 year considered for dosing of PCV15 and PPSV23 in certain cases 1.
Conclusion Not Applicable
Instead, the focus is on the key considerations and recommendations for PCV administration, as outlined above. The most recent and highest quality study, published in 2024 1, provides the basis for these recommendations.
From the Research
Pneumococcal Conjugate Vaccine (PCV) Assessment
- Pneumonia should be assessed to determine the needed Pneumococcal Conjugate Vaccine (PCV) as the effectiveness of PCV13 against pneumococcal pneumonia hospitalization in older adults has been evaluated in several studies 2, 3, 4, 5.
- The Advisory Committee on Immunization Practices (ACIP) recommends routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, administered in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2.
- The effectiveness of PCV13 against pneumococcal pneumonia has been shown to be moderate, with an adjusted vaccine effectiveness (VE) of 40.0% (95% confidence interval [CI], -10.8% to 67.5%) in adults aged ≥65 years 3.
- Sequential PCV13/PPSV23 vaccination has been shown to be most effective for preventing pneumococcal community-acquired pneumonia (CAP) among adults aged 65-74 years, with an adjusted VE of 80.3% (95% CI, 15.9%-95.4%) 3.
Vaccine Recommendations
- The U.S. Centers for Disease Control and Prevention recommend that adults at risk for pneumococcal pneumonia, including those over 65 years of age and those with chronic disease, should receive the 23-polysaccharide vaccine 6.
- Adults should be revaccinated once at age 65 years or older with the 23-polysaccharide vaccine, provided that at least 5 years have elapsed since the previous vaccination 6.
- Immunosuppressed patients of any age should receive both PCV13 and PPSV23 vaccines 6.
Vaccine Efficacy and Safety
- PCV13 has been shown to have a favorable safety profile, with an opsonophagocytic activity (OPA) response generally greater than PPSV23, irrespective of age and previous pneumococcal vaccination 5.
- PCV13 priming has been shown to enhance immune responses with subsequent PCV13 or PPSV23 dosing, while PPSV23 has been shown to blunt the response to subsequent PCV13 5.
- The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) demonstrated PCV13 efficacy for at least five years against both vaccine-serotype invasive pneumococcal disease (VT-IPD) and vaccine-serotype pneumococcal community-acquired pneumonia (VT-CAP) 4, 5.