What is the recommended vaccination schedule for pneumococcal disease using only Pneumococcal Conjugate Vaccine 13 (PCV13) and Pneumococcal Polysaccharide Vaccine 23 (PPSV23)?

Pneumococcal Vaccination Schedule Using PCV13 and PPSV23

For optimal protection against pneumococcal disease, PCV13 should be administered first, followed by PPSV23 after an appropriate interval based on age and risk factors. 1, 2

Vaccination Schedules by Age Group and Risk Factors

Children Under 2 Years

• Routine PCV13 series: 4 doses at 2,4,6, and 12-15 months of age
• PPSV23 not recommended for this age group

Children 2-18 Years with High-Risk Conditions

• Children with underlying medical conditions who completed PCV13 series:

  • Administer 1 dose of PPSV23 at age ≥2 years and at least 8 weeks after the most recent dose of PCV13 1

• Children 24-71 months with underlying conditions with incomplete vaccination:

  • If received <3 doses of PCV before age 24 months: 2 doses of PCV13 followed by PPSV23 ≥8 weeks later
  • If received 3 doses of PCV before age 24 months: 1 dose of PCV13 followed by PPSV23 ≥8 weeks later 1

• Children 6-18 years with high-risk conditions who never received PCV13:

  • Administer 1 dose of PCV13 regardless of previous PPSV23 history
  • If PPSV23 was already given, administer PCV13 ≥8 weeks after PPSV23
  • If PPSV23 not yet given, administer PPSV23 ≥8 weeks after PCV13 1

Adults 19-64 Years with Risk Conditions

• Adults with immunocompromising conditions, CSF leaks, or cochlear implants:

  • PCV13 first, then PPSV23 ≥8 weeks later 2
  • If previously received PPSV23, give PCV13 ≥1 year after PPSV23 3

• Adults with chronic medical conditions (diabetes, heart/lung/liver disease, alcoholism, smoking):

  • PCV13 first, then PPSV23 ≥1 year later 1, 2
  • If previously received PPSV23, give PCV13 ≥1 year after PPSV23 3

Adults ≥65 Years

• Adults who have not received any pneumococcal vaccine:

  • PCV13 first, then PPSV23 ≥1 year later 2
  • For immunocompromised adults ≥65 years: PCV13 first, then PPSV23 ≥8 weeks later 2

• Adults who previously received PPSV23 before age 65:

  • Give PCV13 ≥1 year after previous PPSV23 dose
  • Then give another PPSV23 dose ≥1 year after PCV13 and ≥5 years after previous PPSV23 2

Special Populations

Hematopoietic Stem Cell Transplant Recipients

• 3 doses of PCV13, 4 weeks apart, starting 3-6 months after transplant
• Fourth dose of PCV13 ≥6 months after third dose or ≥12 months after transplant (whichever is later) 1

Revaccination with PPSV23

• For patients with anatomic/functional asplenia, HIV infection, or immunocompromising conditions:
  • Second dose of PPSV23 recommended 5 years after first PPSV23 dose
  • No more than 2 PPSV23 doses recommended 1

Important Timing Considerations

• Minimum interval between PCV13 and PPSV23: 8 weeks for immunocompromised patients; 1 year for non-immunocompromised patients 2, 3
• Minimum interval when PPSV23 given first: Wait at least 1 year before giving PCV13 3
• Pre-surgical vaccination: Complete pneumococcal vaccination at least 2 weeks before elective splenectomy, immunocompromising therapy, or cochlear implant placement 1

Clinical Pearls

• PCV13 provides better immune memory and longer-lasting protection than PPSV23 2
• Sequential use of both vaccines provides broader serotype coverage and optimal protection 4, 5
• PCV13 shows significant immune response after the first dose in immunocompromised patients, with modest increases after subsequent doses 5
• The combination of PCV13 and PPSV23 is cost-effective, particularly in immunocompromised populations 4

Following these schedules will optimize protection against pneumococcal disease while minimizing the number of vaccine doses required.