Who should receive the pneumonia vaccine?

Pneumococcal Vaccination Recommendations

All adults aged ≥65 years and persons aged 2-64 years with specific high-risk conditions should receive pneumococcal vaccination to reduce morbidity and mortality from invasive pneumococcal disease. 1

Who Should Receive Pneumococcal Vaccination

Adults ≥65 Years

• All adults in this age group should be vaccinated regardless of previous vaccination status 2, 1
• Effectiveness against invasive pneumococcal disease in this population ranges from 44-75% 1

Persons Aged 2-64 Years with High-Risk Conditions

Individuals with the following conditions should receive pneumococcal vaccination:

• Chronic Medical Conditions:

  • Chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies)
  • Chronic pulmonary disease (e.g., COPD, emphysema)
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease (cirrhosis)
  • Cerebrospinal fluid leaks 2, 1

• Immunocompromising Conditions:

  • Functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
  • HIV infection
  • Leukemia, lymphoma, Hodgkin's disease, multiple myeloma
  • Generalized malignancy
  • Chronic renal failure, nephrotic syndrome
  • Organ or bone marrow transplantation
  • Immunosuppressive therapy including long-term corticosteroids 2, 1

• Other High-Risk Groups:

  • Current smokers 2
  • Native Americans and Alaska Natives 2
  • Residents of long-term care facilities 2, 1
  • Persons with cochlear implants 1

Vaccination Schedule and Administration

Standard Schedule

• For adults ≥65 years: One dose of pneumococcal vaccine 2
• One-time revaccination after 5 years for:
  1. Adults ≥65 years who received first dose before age 65
  2. Persons with asplenia
  3. Immunocompromised persons 2, 1

Administration

• Administered intramuscularly or subcutaneously as one 0.5-mL dose 2
• Can be administered concurrently with influenza vaccine (at different injection sites) without decreased efficacy or increased side effects 2, 1
• Pneumococcal vaccine can be administered with other vaccines without increasing reaction severity or diminishing antibody response 2

Special Considerations

Asplenic Patients

• Should be informed that vaccination does not guarantee protection against fulminant pneumococcal disease (case-fatality rate 50-80%) 2
• Should receive prompt medical attention for unexplained fever or sepsis symptoms 2
• For elective splenectomy, administer vaccine at least 2 weeks before surgery 2

Transplant Recipients

• Solid organ transplant recipients require a special vaccination schedule with multiple doses 1

Immunocompromised Patients

• Vaccine effectiveness may be reduced but is still recommended due to higher risk of severe disease 1
• Should receive vaccination before starting immunosuppressive therapy when possible 1

Implementation Tips

• Do not withhold vaccination if immunization records are unavailable; use patient's verbal history 1
• Establish standing order programs for administering pneumococcal vaccine to high-risk residents 1
• Assess vaccination status during routine healthcare visits, especially for adults aged 50-64 years who commonly have chronic illnesses 2
• For younger adults (65-74 years), sequential PCV13/PPSV23 vaccination has shown the highest effectiveness (80.3%) against pneumococcal pneumonia 3

Common Pitfalls to Avoid

1. Missing high-risk younger adults: Don't overlook vaccination for adults <65 years with chronic conditions, as they have a persistent pneumococcal disease burden 4

2. Inadequate revaccination: Ensure appropriate revaccination for those who received their first dose before age 65 or have immunocompromising conditions 2

3. Delaying vaccination due to missing records: Proceed with vaccination if history is uncertain rather than delaying protection 1

4. Overlooking vaccination in long-term care settings: Nursing facilities are required to assess pneumococcal vaccination status and administer appropriate vaccines 5

By following these recommendations, healthcare providers can help achieve the national objectives for pneumococcal vaccination coverage and significantly reduce the burden of pneumococcal disease.