What is the recommended pneumococcal (Pneumonia) vaccine schedule?

Pneumococcal Vaccine Recommendations

For adults aged ≥19 years, a single dose of PCV20 is recommended as the preferred pneumococcal vaccination option for those who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown. 1

General Recommendations by Age Group

Adults aged 19-64 years without risk factors:

• No routine pneumococcal vaccination is recommended 1

Adults aged 19-64 years with chronic medical conditions:

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

Chronic medical conditions include:

• Alcoholism 1
• Chronic heart disease (including congestive heart failure and cardiomyopathies) 1
• Chronic liver disease 1
• Chronic lung disease (including COPD, emphysema, and asthma) 1
• Cigarette smoking 1
• Diabetes mellitus 1

Adults aged 19-64 years with immunocompromising conditions:

• Option A (preferred): Single dose of PCV20 1
• Option B: Single dose of PCV15, followed by PPSV23 after ≥8 weeks 1

Immunocompromising conditions include:

• Chronic renal failure 1
• Congenital or acquired asplenia 1
• Congenital or acquired immunodeficiency 1
• HIV infection 1
• Generalized malignancy 1
• Hematologic malignancies (Hodgkin disease, leukemia, lymphoma, multiple myeloma) 1
• Solid organ transplant 1
• Iatrogenic immunosuppression 1

Adults aged ≥65 years:

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

Special Population: Hematopoietic Stem Cell Transplant Recipients

For adults ≥19 years who received hematopoietic stem cell transplant (HSCT):

• Option A: Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT. Administer a fourth PCV20 dose ≥6 months after the third dose or ≥12 months after HSCT, whichever is later 1
• Option B: Administer 3 doses of PCV15, 4 weeks apart starting 3-6 months after HSCT, followed by PPSV23 ≥12 months after HSCT if no chronic graft-versus-host disease (GVHD). If patient has chronic GVHD, administer a fourth dose of PCV15 in place of PPSV23 1

Recommendations for Previously Vaccinated Adults

For those who previously received PPSV23 only:

• Administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 1

For those who previously received PCV13 only:

• Administer a single dose of PCV20 after a ≥1 year interval since the last PCV13 dose 1

For those who previously received both PCV13 and PPSV23:

• No additional vaccines are recommended until age 65 years 1

Clinical Considerations

• Sequential PCV13/PPSV23 vaccination has shown the highest effectiveness (80.3%) against pneumococcal community-acquired pneumonia in adults aged 65-74 years 2
• The newer PCV20 provides broader serotype coverage compared to PCV13, potentially offering improved protection against more pneumococcal strains 3
• Recent evidence suggests expanding age-based PCV recommendations to include adults aged 50-64 years 4

Common Pitfalls and Caveats

• Failure to recognize immunocompromising conditions that require a different vaccination schedule (shorter interval between PCV15 and PPSV23) 1
• Not accounting for previous pneumococcal vaccination history when determining current recommendations 1
• Overlooking the special vaccination schedule required for HSCT recipients 1
• Not reviewing pneumococcal vaccination recommendations when patients turn 65 years old, even if they previously received pneumococcal vaccines 1
• Medicare Part B covers influenza and pneumococcal vaccines for eligible beneficiaries 5