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

Latest Guidelines for Pneumococcal Vaccination (2023)

For adults, a single dose of PCV20 is the preferred vaccination strategy for pneumococcal disease prevention according to the 2023 Advisory Committee on Immunization Practices (ACIP) recommendations. 1

General Vaccination Approach by Age Group

Adults ≥65 years

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

Adults 19-64 years with Chronic Medical Conditions

Conditions include: alcoholism, chronic heart/lung/liver disease, diabetes, cigarette smoking

• Option A (Preferred): Single dose of PCV20
• Option B: PCV15 followed by PPSV23 (≥1 year interval)

Adults 19-64 years with Immunocompromising Conditions

Conditions include: asplenia, immunodeficiencies, HIV, malignancies, immunosuppressive therapy, organ transplant

• Option A (Preferred): Single dose of PCV20
• Option B: PCV15 followed by PPSV23 (≥8 weeks interval)

Specific Recommendations for Previously Vaccinated Patients

For patients who previously received PPSV23 only

• Administer PCV20 ≥1 year after the last PPSV23 dose 1

For patients who previously received PCV13 only

• Administer PCV20 ≥1 year after the PCV13 dose 1
• If using Option B: Administer PPSV23 ≥1 year after PCV13 for healthy adults or ≥8 weeks for immunocompromised patients

For patients who received both PCV13 and PPSV23

• If patient has not yet received PPSV23 at age ≥65: Administer PCV20 ≥5 years after the last pneumococcal vaccine dose 1
• If patient received PPSV23 at age ≥65: Consider administering PCV20 ≥5 years after the last pneumococcal vaccine dose (shared decision-making recommended) 1

Special Populations

Hematopoietic Stem Cell Transplant Recipients

• Recommended schedule: 4 doses of PCV20, starting 3-6 months after HSCT
• Administer 3 doses 4 weeks apart, then a fourth dose ≥6 months after the third dose or ≥12 months after HSCT (whichever is later) 1
• Alternative if PCV20 unavailable: 3 doses of PCV15 4 weeks apart, followed by PPSV23 ≥1 year after HSCT 1

Important Clinical Considerations

Vaccine Administration

• All pneumococcal vaccines are administered intramuscularly 2
• Can be administered with other age-appropriate vaccines during the same visit 3

Vaccine Selection Rationale

• PCVs (PCV15/PCV20) provide better immune memory and longer-lasting protection than PPSV23 3
• PCV20 covers additional serotypes compared to PCV15, offering broader protection 2
• The single-dose PCV20 strategy simplifies the vaccination schedule and may improve compliance 1

Common Pitfalls to Avoid

1. Incorrect intervals: Respect minimum intervals between vaccines (≥1 year between PPSV23 and any PCV for most patients; ≥8 weeks for immunocompromised patients)
2. Overlooking reassessment at age 65: All adults should have their pneumococcal vaccination status reassessed at age 65 3
3. Missing high-risk patients: Ensure all patients with qualifying medical conditions receive appropriate vaccination, even if under age 65
4. Ignoring vaccination history: Always check previous pneumococcal vaccination history to determine appropriate next steps

Conclusion

The 2023 ACIP guidelines represent a significant simplification of pneumococcal vaccination recommendations, with a preference for the single-dose PCV20 strategy across all adult age groups and risk categories. This approach aims to improve vaccination coverage and reduce the burden of pneumococcal disease.