What are the pneumococcal (pneumonia) vaccine guidelines in Canada?

Canadian Pneumococcal Vaccination Guidelines

The National Advisory Committee on Immunization (NACI) in Canada recommends pneumococcal vaccination for all adults aged 65 years and older, adults with specific risk factors, and children according to age-appropriate schedules, with the preferred option being a single dose of 20-valent pneumococcal conjugate vaccine (PCV20) for adults or a sequential regimen of PCV15 followed by PPSV23 as an alternative. 1

Adult Vaccination Recommendations

Adults 65 Years and Older

• All adults ≥65 years should receive pneumococcal vaccination regardless of risk factors 2
• Preferred option: Single dose of PCV20 1
• Alternative option: PCV15 followed by PPSV23 at least 8 weeks later 1

Adults 50-64 Years

• Recommended for those with risk factors for pneumococcal disease 1
• Risk factors include:
  • Chronic medical conditions (heart disease, lung disease, liver disease, diabetes)
  • Cerebrospinal fluid leaks
  • Cochlear implants
  • Functional or anatomic asplenia
  • Immunocompromising conditions
  • Solid organ transplants
  • Immunosuppressive therapy 2

Adults 18-49 Years

• Recommended for those with immunocompromising conditions 1
• This includes:
  • HIV infection
  • Leukemia, lymphoma, Hodgkin's disease
  • Multiple myeloma
  • Generalized malignancy
  • Chronic renal failure
  • Nephrotic syndrome
  • Organ or bone marrow transplantation
  • Immunosuppressive therapy including long-term corticosteroids 3

Pediatric Vaccination Recommendations

• Routine pneumococcal conjugate vaccination recommended at 2,4,6, and 12-15 months of age 2
• Children aged ≥2 years with underlying medical conditions should receive PPSV23 after completing all recommended doses of PCV13 3
• For children with high-risk conditions (functional or anatomic asplenia, immunocompromising conditions):
  • A second dose of PPSV23 is recommended 5 years after the first dose 3
  • No more than 2 PPSV23 doses are recommended 3

Special Populations

Immunocompromised Patients

• Should receive both PCV13/PCV15/PCV20 and PPSV23 vaccines 3
• When both vaccines are required, the conjugate vaccine should be given first, followed by PPSV23 at least 8 weeks later 3
• Ideally, vaccination should be completed at least 2 weeks before starting immunosuppressive therapy 3

Patients with Inflammatory Bowel Disease (IBD)

• All pediatric patients with IBD should receive age-appropriate pneumococcal vaccines 3
• Adult patients with IBD and risk factors should receive pneumococcal vaccines 3
• All adults with IBD on immunosuppressive therapy should receive pneumococcal vaccines regardless of other risk factors 3

Solid Organ Transplant Recipients

• Require special vaccination schedule: three doses of PCV20 (or PCV15), 4 weeks apart, starting 3-6 months after transplant
• Fourth dose of PCV20 (or PCV15) at least 6 months after the third dose or at least 12 months after transplant, whichever is later 2

Revaccination Guidelines

• For high-risk individuals (asplenia, immunocompromising conditions), a second dose of PPSV23 is recommended 5 years after the first dose 3
• For patients who previously received PPSV23 but not PCV, a dose of PCV20 should be administered at least 1 year after the last PPSV23 dose 2
• For patients who previously received PCV13, a dose of PCV20 can be given to provide broader serotype coverage 2

Clinical Burden and Benefits of Vaccination

• Pneumococcal disease burden is highest in children <5 years and adults >70 years 4
• Adults aged 50-64 years with pneumococcal community-acquired pneumonia (pCAP) contribute significantly to disease burden, suggesting benefit from age-based recommendation for adults ≥50 years 5
• Pneumococcal vaccination has shown to reduce the incidence of invasive pneumococcal disease and pneumococcal pneumonia in Canada 4
• Vaccination effectiveness may be reduced in immunocompromised patients but is still recommended due to higher risk of severe disease 2

Implementation Considerations

• Establish standing order programs for pneumococcal vaccination in high-risk populations 2
• Do not withhold vaccination in the absence of an immunization record; use patient's verbal history 2
• When indicated, administer vaccine to patients uncertain about their vaccination history 2
• Pneumococcal vaccines are inactivated and considered safe for immunocompromised patients 2

Common Pitfalls and Caveats

• Pneumococcal vaccination rates among Canadian adults remain suboptimal 6
• Response to pneumococcal vaccines may be impaired in patients on immunosuppressive therapy 3
• Vaccine should be administered before starting immunosuppressive therapy when possible 3
• Pneumococcal vaccines are safe with no evidence of increased adverse events in immunocompromised patients 2
• Do not miss opportunities to vaccinate adults with chronic conditions whose baseline risk is often higher than healthy individuals aged 65 years and older 6