What pneumonia vaccines should be administered to a patient with a history of smoking (tobacco use)?

From the Guidelines

For smokers, I recommend a single dose of PCV21, PCV20, or PCV15, with PCV15 followed by a dose of PPSV23 at least 1 year later, as the most effective pneumococcal vaccination strategy, according to the latest guidelines from 2024 1. This recommendation is based on the patient's history of smoking, which significantly increases the risk of pneumococcal disease by damaging respiratory defenses and impairing ciliary function.

• The patient's age and other underlying medical conditions should be considered when determining the best vaccination strategy.
• The vaccines are generally well-tolerated with possible mild side effects like soreness at the injection site, fatigue, or low-grade fever.
• No prescription is needed as these vaccines are available at most pharmacies and primary care offices.
• It is essential to follow the recommended vaccination schedule to ensure optimal protection against pneumococcal disease. Some key points to consider when administering pneumococcal vaccines to smokers include:
• The use of PCV21, PCV20, or PCV15 as the primary vaccine, with PCV15 followed by PPSV23 at least 1 year later.
• The importance of considering the patient's age and other underlying medical conditions when determining the best vaccination strategy.
• The potential for shorter intervals between vaccine doses for adults with immunocompromising conditions, a CSF leak, or a cochlear implant, as noted in the 2023 guidelines 1. However, the 2024 guidelines 1 take precedence, and the recommendation for a single dose of PCV21, PCV20, or PCV15, with PCV15 followed by PPSV23 at least 1 year later, is the most up-to-date and effective strategy for smokers.

From the Research

Pneumonia Vaccines for Patients with a History of Smoking

• Patients with a history of smoking (tobacco use) are at increased risk for pneumococcal disease, and vaccination is an effective way to prevent this disease 2, 3, 4, 5, 6
• The two main types of pneumococcal vaccines are:
  • 23-valent pneumococcal polysaccharide vaccine (PPV23)
  • 13-valent pneumococcal conjugate vaccine (PCV13)
• More recently, 15-valent pneumococcal conjugate vaccine (PCV15) and 20-valent pneumococcal conjugate vaccine (PCV20) have been developed and recommended for use in adults 6
• The Advisory Committee on Immunization Practices (ACIP) recommends the use of either PCV20 alone or PCV15 in series with PPSV23 for all adults aged ≥65 years, and for adults aged 19-64 years with certain underlying medical conditions or other risk factors, including those with a history of smoking 6
• PCV13 has been shown to elicit a functional immune response and is noninferior to PPV23 for all 12 serotypes common to the two vaccines 2
• PCV13 has also been shown to provide long-acting immunologic memory and an anamnestic response, making it a more effective vaccine than PPV23 for non-bacteremic pneumococcal pneumonia 3

Vaccine Administration

• The vaccine administration schedule and recommendations vary by age and risk factors, and patients with a history of smoking should consult with their healthcare provider to determine the best vaccination strategy 4, 5, 6
• Vaccination with PCV13, PCV15, or PCV20 can provide protection against pneumococcal disease, and the choice of vaccine and administration schedule should be based on individual patient risk factors and medical history 2, 3, 4, 5, 6