What is the recommended schedule for Pneumococcal Polysaccharide Vaccine (PPSV 23)?

Pneumococcal Polysaccharide Vaccine (PPSV23) Schedule Recommendations

The current recommendation for PPSV23 has shifted toward using newer pneumococcal conjugate vaccines (PCV15 or PCV20) as preferred options, with PPSV23 primarily used as a follow-up dose when PCV15 is administered. 1

General Recommendations by Age and Risk Group

Adults ≥65 Years

• Option A (Preferred): Single dose of PCV20
• Option B: Single dose of PCV15, followed by PPSV23 ≥1 year later (or ≥8 weeks later for immunocompromised patients)

Adults 19-64 Years with Chronic Medical Conditions

Conditions include: alcoholism, chronic heart/liver/lung disease, smoking, diabetes

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

Adults 19-64 Years with Immunocompromising Conditions

Conditions include: chronic renal failure, asplenia, immunodeficiency, malignancy, HIV, immunosuppressive therapy, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease, solid organ transplant

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

Recommendations for Those Previously Vaccinated

If Previously Received PPSV23 Only

• Administer a single dose of PCV20 or PCV15 ≥1 year after the last PPSV23 dose
• No additional PPSV23 dose is needed after PCV20 or PCV15 1, 2

If Previously Received PCV13 Only

• For adults ≥65 years: Administer PCV20 ≥1 year after PCV13 OR PPSV23 ≥1 year after PCV13 (≥8 weeks for immunocompromised)
• For adults 19-64 years with chronic conditions: Administer PCV20 or PPSV23 ≥1 year after PCV13

If Previously Received Both PCV13 and PPSV23

• For adults ≥65 years who haven't received PPSV23 at age ≥65: Administer PCV20 ≥5 years after last dose OR PPSV23 ≥1 year after PCV13 and ≥5 years after last PPSV23
• For adults 19-64 years with chronic conditions: No additional vaccines until age 65

Special Populations

Hematopoietic Stem Cell Transplant Recipients

• Recommended schedule: 4 doses of PCV20, starting 3-6 months after HSCT
  • First 3 doses: 4 weeks apart
  • Fourth dose: ≥6 months after third dose or ≥12 months after HSCT (whichever is later)
• Alternative if PCV20 unavailable: 3 doses of PCV15 4 weeks apart, followed by PPSV23 ≥1 year after HSCT 1

Important Considerations

1. Timing matters: Respect minimum intervals between vaccines:

   • ≥1 year between PPSV23 and any PCV (PCV15/PCV20)
   • ≥8 weeks between PCV15 and PPSV23 for immunocompromised patients
   • ≥1 year between PCV15 and PPSV23 for non-immunocompromised patients 1, 2

2. Avoid same-day administration: PCV15 and PPSV23 should not be administered during the same visit 1

3. Prior vaccination with PCV7: Adults who received only PCV7 should be vaccinated according to recommendations for adults who haven't received any pneumococcal vaccine 1

4. Immunologic advantages: PCVs (PCV15/PCV20) have immunologic advantages over PPSV23, including better immune memory and longer-lasting protection 1, 3

5. Reassess at age 65: For adults vaccinated before age 65, reassess pneumococcal vaccination status when they turn 65 1

Common Pitfalls to Avoid

1. Administering PPSV23 too soon after PCV15: This may reduce the immune response to PPSV23

2. Missing vaccination opportunities: Assess vaccination status at every clinical encounter for high-risk adults 2, 4

3. Assuming prior PPSV23 completes the series: Current guidelines recommend adding a PCV (PCV15/PCV20) even if PPSV23 was previously given 1, 2

4. Overlooking the impact of prior PPSV23 on PCV response: A prior dose of PPSV23 can diminish the response to subsequent PCV13 administration 3

5. Forgetting special populations: Immunocompromised patients need shorter intervals between PCV15 and PPSV23 (≥8 weeks vs ≥1 year) 1, 2

The ACIP's shift toward preferring PCV20 or the PCV15-PPSV23 series reflects the immunologic advantages of conjugate vaccines while still utilizing PPSV23's broader serotype coverage when needed.