Can a patient over 65 with asthma receive PCV-20 (Pneumococcal Conjugate Vaccine) four years after receiving PCV-23 (Pneumococcal Conjugate Vaccine)?

Pneumococcal Vaccination for a Patient Over 65 with Asthma Who Received PCV-23 in 2021

Yes, a patient over 65 with asthma can receive PCV-20 four years after receiving PCV-23, as the CDC recommends administering PCV-20 after a ≥1 year interval since the last PPSV23 dose. 1

Vaccination Recommendation Based on Patient Profile

This patient fits into two important categories:

• Age ≥65 years (higher risk age group)
• Has asthma (chronic lung disease, a risk factor)
• Previously received PPSV23 in 2021

Specific Recommendation

According to the 2023 ACIP recommendations, for adults who have received PPSV23 only:

• PCV-20 can be administered ≥1 year after the last PPSV23 dose 1
• Since this patient received PPSV23 in 2021, and it's now been 4 years, the timing requirement has been met

Rationale for Recommendation

1. Broader serotype coverage: PCV-20 provides protection against additional pneumococcal serotypes compared to the patient's previous PPSV23 vaccination

2. Risk factors: The patient has two significant risk factors:

   • Age ≥65 years
   • Asthma (classified as chronic lung disease)

3. Timing considerations: The minimum interval of ≥1 year between PPSV23 and any PCV has been exceeded (4 years have passed) 1

Vaccination Schedule Options

For patients who have previously received PPSV23 only, the 2023 ACIP guidelines provide two options:

1. Preferred option: Administer a single dose of PCV-20 after a ≥1 year interval since the last PPSV23 dose 1

2. Alternative option: Administer a single dose of PCV-15 after a ≥1 year interval since the last PPSV23 dose 1

Important Considerations

• No need for additional doses: After receiving PCV-20, no additional pneumococcal vaccines are needed for this patient 1

• Vaccine effectiveness: Sequential vaccination with conjugate vaccines after polysaccharide vaccines has shown improved effectiveness, particularly in adults aged 65-74 years 2

• Avoid common pitfalls:

  • Do not administer pneumococcal vaccines simultaneously
  • Ensure proper documentation of previous vaccination to avoid unnecessary revaccination
  • Remember that conjugate vaccines (PCV) provide better immune memory and longer-lasting protection than polysaccharide vaccines (PPSV23) 3

Conclusion

The patient should receive PCV-20 now, as they meet all criteria:

• It has been more than 1 year since their PPSV23 dose (4 years)
• They have risk factors (age ≥65 and asthma)
• PCV-20 will provide broader serotype coverage

This recommendation aligns with the most recent 2023 ACIP guidelines for pneumococcal vaccination in adults.