What are the CDC guidelines for pneumococcal (Streptococcus pneumoniae) vaccination?

CDC Guidelines on Pneumococcal Vaccination

The CDC recommends either a single dose of 20-valent pneumococcal conjugate vaccine (PCV20) alone or 15-valent pneumococcal conjugate vaccine (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged ≥65 years and for adults aged 19-64 years with certain underlying medical conditions. 1

Recommendations by Age and Risk Factors

Adults ≥65 Years

• Option A: Single dose of PCV20
• Option B: PCV15 followed by PPSV23 (≥1 year interval for immunocompetent adults; ≥8 weeks interval for immunocompromised adults)

Adults 19-64 Years with Underlying Medical Conditions

High-risk conditions requiring vaccination:

• Chronic medical conditions (alcoholism, chronic heart/liver/lung disease, diabetes, smoking)
• Immunocompromising conditions (chronic renal failure, asplenia, immunodeficiency, HIV, malignancy, immunosuppressive therapy, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease, solid organ transplant)
• CSF leaks or cochlear implants

Vaccination Schedules Based on Prior Vaccination History

For Previously Unvaccinated Adults or Those with Unknown History

• Option A: Single dose of PCV20
• Option B: PCV15 followed by PPSV23 (with appropriate interval based on risk factors)

For Adults Previously Vaccinated with PPSV23 Only

• Administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1, 2

For Adults Previously Vaccinated with PCV13 Only

• Administer PCV20 ≥1 year after PCV13, OR
• Complete series with PPSV23:
  • ≥8 weeks after PCV13 for immunocompromised adults
  • ≥1 year after PCV13 for immunocompetent adults 1

For Adults Who Received Both PCV13 and PPSV23

• If PPSV23 was given at age ≥65 years: Shared clinical decision-making regarding a supplemental PCV20 dose (≥5 years after last dose)
• If PPSV23 was not given at age ≥65 years: Administer PCV20 or PPSV23 at age ≥65 years (≥5 years after previous PPSV23) 1

Special Populations

Hematopoietic Stem Cell Transplant Recipients

• Recommended schedule: 4 doses of PCV20
  • 3 doses given 4 weeks apart, starting 3-6 months after HSCT
  • 4th dose ≥6 months after 3rd 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

Implementation Considerations

Administration Guidelines

• Administer intramuscularly or subcutaneously into deltoid muscle or lateral mid-thigh 3
• Use separate sterile syringe and needle for each patient 3
• Do not mix with other vaccines in the same syringe or vial 3

Common Pitfalls to Avoid

1. Failing to check vaccination history - Always verify previous pneumococcal vaccination status
2. Incorrect intervals between vaccines - Maintain minimum intervals based on risk factors
3. Overlooking high-risk conditions - Ensure all qualifying medical conditions are identified
4. Confusion about newer recommendations - The 2023 guidelines have simplified previous recommendations by focusing on higher-valency conjugate vaccines

Coadministration Considerations

• PCV and PPSV23 should not be administered simultaneously
• Pneumococcal vaccines can be administered with most other vaccines, but proper administration techniques should be followed 2

Rationale for Current Recommendations

The 2023 CDC guidelines represent a significant update from previous recommendations, moving from complex, risk-based schedules to more streamlined options using newer, higher-valency vaccines. This approach aims to improve protection against pneumococcal disease while simplifying the vaccination process for healthcare providers and patients, ultimately improving vaccination rates and reducing morbidity and mortality from pneumococcal disease.