When is pneumococcal (PCV) vaccine indicated?

Pneumococcal Vaccine Indications

Pneumococcal vaccination is indicated for all adults aged ≥65 years and for adults aged 19-64 years with specific underlying medical conditions or risk factors that increase their susceptibility to pneumococcal disease. 1

Indications by Age Group

Adults ≥65 years:

• All adults in this age group should receive pneumococcal vaccination regardless of medical history or risk factors 1, 2
• Recommended options:
  • One dose of PCV20 alone, OR
  • One dose of PCV15 followed by a dose of PPSV23 ≥1 year later 1

Adults 19-64 years with specific medical conditions:

Vaccination is indicated for those with:

Chronic Medical Conditions:

• Chronic heart disease (congestive heart failure, cardiomyopathies) 1
• Chronic lung disease (COPD, emphysema, asthma) 1
• Diabetes mellitus 1
• Alcoholism 1
• Chronic liver disease (cirrhosis) 1
• Cigarette smoking 1
• Chronic renal failure 1
• CSF leaks 1

Immunocompromising Conditions:

• Congenital or acquired asplenia 1
• Sickle cell disease or other hemoglobinopathies 1
• HIV infection 1
• Congenital or acquired immunodeficiencies 1
• Generalized malignancy 1
• Hodgkin disease 1
• Leukemia 1
• Lymphoma 1
• Multiple myeloma 1
• Nephrotic syndrome 1
• Solid organ transplant 1
• Iatrogenic immunosuppression (including long-term systemic corticosteroids) 1
• Cochlear implant 1

Vaccination Recommendations by Risk Group

For immunocompetent adults with chronic conditions:

• Option A: Single dose of PCV20, OR
• Option B: Single dose of PCV15, followed by PPSV23 ≥1 year later 2

For immunocompromised adults:

• Option A: Single dose of PCV20, OR
• Option B: Single dose of PCV15, followed by PPSV23 ≥8 weeks later 2
  • The shorter interval (8 weeks vs 1 year) is recommended due to higher risk of pneumococcal disease 1

For persons living in special environments:

• Residents of nursing homes and long-term care facilities 1
• Certain American Indian and Alaskan Native populations 1

Timing Considerations

For elective splenectomy:

• Administer pneumococcal vaccine at least 2 weeks before surgery 1

For patients undergoing immunosuppressive therapy:

• Vaccinate at least 2 weeks before initiating immunosuppressive therapy 1

For hematopoietic stem cell transplant recipients:

• Recommended schedule: 4 doses of PCV20, with 3 doses given 4 weeks apart starting 3-6 months after HSCT, and the 4th dose ≥6 months after the 3rd dose 2

Important Clinical Considerations

• Adults with multiple risk factors should still receive only the recommended single dose of PCV20 or PCV15 followed by PPSV23 1
• For patients who previously received PPSV23, wait at least 1 year before administering PCV20 or PCV15 2
• Pneumococcal vaccines should not be co-administered with Zostavax (separate by at least 4 weeks) 2
• Always check previous vaccination history to avoid unnecessary revaccination 2
• Patients with asplenia should be informed that vaccination does not guarantee protection against fulminant pneumococcal disease, which has a 50-80% case-fatality rate 1

Special Populations

Inflammatory Bowel Disease (IBD):

• Adult patients with IBD should receive pneumococcal vaccination, particularly if they have additional risk factors or are on immunosuppressive therapy 1
• Pediatric patients with IBD should receive age-appropriate pneumococcal vaccines 1

By following these evidence-based recommendations, clinicians can help reduce the burden of pneumococcal disease, which remains a significant cause of morbidity and mortality, especially among older adults and those with underlying medical conditions.