What are the recommendations for pneumonia vaccine administration?

Pneumococcal Vaccine Recommendations

Pneumococcal vaccination is strongly recommended for all adults aged ≥65 years and for persons aged 2-64 years with specific high-risk conditions to reduce morbidity and mortality from invasive pneumococcal disease. 1

Current Pneumococcal Vaccine Options

There are two main types of pneumococcal vaccines available:

1. Pneumococcal Conjugate Vaccines (PCVs):

   • PCV20 (Prevnar20) or PCV15 (VAXNEUVANCE)
   • Recommended for adults ≥50 years of age 2

2. Pneumococcal Polysaccharide Vaccine (PPSV23):

   • 23-valent vaccine (Pneumovax23)
   • Covers 23 serotypes of pneumococcus

Recommendations by Age and Risk Group

Adults ≥65 Years

• All adults in this age group should receive pneumococcal vaccination regardless of previous vaccination status 1
• Options include:
  • A single dose of PCV20 alone, OR
  • PCV15 followed by PPSV23 (with at least 8 weeks between doses) 3

Adults 50-64 Years

• All adults in this age group should receive a single dose of PCV 2
• Current smokers in this age group should receive pneumococcal vaccination 1

Adults 19-49 Years with Risk Conditions

• Vaccination recommended for those with:
  • Chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathy)
  • Chronic pulmonary disease (e.g., COPD, emphysema, but not asthma)
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease (cirrhosis)
  • Cerebrospinal fluid leaks
  • Functional or anatomic asplenia
  • Immunocompromising conditions/medications
  • Cochlear implants
  • Residence in long-term care facilities 1, 4

Children

• Children aged <2 years: PCV series recommended at 2,4,6, and 12-15 months 4
• Children aged ≥2 years with underlying medical conditions: Should receive PPSV23 after completing all recommended doses of PCV13 4

Revaccination Guidelines

• One-time revaccination with PPSV23 after 5 years is recommended for:

  1. Adults ≥65 years who received their first dose before age 65
  2. Persons with asplenia
  3. Immunocompromised persons 1

• No more than two total lifetime doses of PPSV23 are recommended 4

Special Populations

Immunocompromised Patients

• Should receive pneumococcal vaccination according to age and risk-appropriate schedules
• May have diminished immune response to vaccination 5
• Ideally, vaccination should be completed at least 2 weeks before starting immunosuppressive therapy 4

Solid Organ Transplant Recipients

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

Administration Considerations

• Pneumococcal vaccine can be administered intramuscularly or subcutaneously 5
• Can be administered concurrently with influenza vaccine (at different injection sites) without decreased efficacy or increased side effects 1
• If vaccination history is unknown, proceed with vaccination rather than withholding it 4

Effectiveness and Benefits

• PPSV23 effectiveness against invasive pneumococcal disease in adults ≥65 years ranges from 44-75% 1
• Efficacy may decrease with advancing age 1
• Vaccination has been shown to be cost-effective for adults ≥50 years 1
• The effectiveness of the vaccine against pneumococcal disease in immunocompromised persons is less clear 1

Common Pitfalls to Avoid

1. Delaying vaccination due to uncertainty about previous vaccination status - when in doubt, vaccinate 4
2. Failing to recognize high-risk conditions that warrant vaccination in younger adults
3. Administering a third dose of PPSV23, which is not recommended due to lack of safety data 1
4. Missing opportunities for vaccination during hospitalizations or routine healthcare visits
5. Not considering pneumococcal vaccination for current smokers, who are at increased risk 1

By following these evidence-based recommendations, clinicians can help reduce the significant morbidity and mortality associated with pneumococcal disease, particularly in vulnerable populations.