What are the guidelines for pneumococcal (pneumonia) vaccine and herpes zoster (shingles) vaccine administration?

Pneumococcal and Herpes Zoster Vaccination Guidelines

For pneumococcal vaccination, adults should receive either PCV20 as a single dose or PCV15 followed by PPSV23 (with appropriate timing based on risk factors), while adults ≥50 years should receive recombinant zoster vaccine (RZV) as a two-dose series regardless of previous zoster history. 1, 2

Pneumococcal Vaccination Guidelines

Adults ≥65 Years

• Option A: Single dose of PCV20
• Option B: PCV15 followed by PPSV23 ≥1 year later (≥8 weeks later for immunocompromised patients) 1, 3

Adults 19-64 Years with Chronic Medical Conditions

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

• Option A: Single dose of PCV20
• Option B: PCV15 followed by PPSV23 ≥1 year later 1, 3

Adults 19-64 Years with Immunocompromising Conditions

Conditions include: chronic renal failure, asplenia, immunodeficiency, HIV, malignancy, immunosuppressive therapy, sickle cell disease, solid organ transplant

• Option A: Single dose of PCV20
• Option B: PCV15 followed by PPSV23 ≥8 weeks later 1

Special Population: Hematopoietic Stem Cell Transplant Recipients

• Option A: 4 doses of PCV20, starting 3-6 months after HSCT
  • Administer 3 doses 4 weeks apart
  • Administer fourth dose ≥6 months after third dose or ≥12 months after HSCT (whichever is later)
• Option B: 3 doses of PCV15 4 weeks apart, followed by PPSV23 ≥1 year after HSCT 1, 3

Timing Considerations for Previous Vaccination

• If previously received PPSV23: Wait ≥1 year before administering PCV20/PCV15
• If previously received PCV13: Wait ≥1 year before administering PCV20 or PPSV23 1, 3

Herpes Zoster Vaccination Guidelines

Recommended Population

• All adults aged ≥50 years should receive herpes zoster vaccination 2
• Particularly important for those with chronic conditions including COPD and asthma who are at increased risk for complications

Recommended Vaccine

• Recombinant adjuvanted zoster vaccine (RZV) is the preferred vaccine
• Administered as a two-dose series, 2-6 months apart
• Provides robust protection against herpes zoster and its complications, including postherpetic neuralgia 2

Special Considerations

• RZV is recommended regardless of:
  • Prior episode of herpes zoster
  • Receipt of older live zoster vaccine (ZVL)
  • Verified history of varicella (chickenpox)
• Those who previously received ZVL should receive the complete RZV series

Clinical Pearls and Pitfalls

For Pneumococcal Vaccination:

• Reassess vaccination status at age 65: All adults should have their pneumococcal vaccination status reassessed at age 65 3
• Minimum intervals: Respect minimum intervals between vaccines to ensure optimal immune response 3
• Co-administration: Pneumococcal vaccines can be administered with other vaccines, including influenza, at the same visit 3
• Pre-surgical timing: Complete pneumococcal vaccination at least 2 weeks before elective splenectomy, immunocompromising therapy, or cochlear implant placement 3

For Herpes Zoster Vaccination:

• Contraindications: RZV should not be administered to persons with a history of severe allergic reaction to any component of the vaccine
• Immunocompromised patients: RZV is recommended for immunocompromised adults ≥50 years, unlike the older live zoster vaccine which was contraindicated in this population
• Timing with other vaccines: RZV can be administered with other adult vaccines, including pneumococcal vaccines

By following these guidelines, healthcare providers can help reduce the burden of pneumococcal disease and herpes zoster in adult populations, particularly among those at highest risk for complications and mortality.