Should an 84-year-old patient who received the PCV (Pneumococcal Conjugate Vaccine) 13 in 2015 and the PPSV (Pneumococcal Polysaccharide Vaccine) 23 in August 2022 receive another pneumonia vaccine in October 2025?

Pneumococcal Vaccination Recommendation for an 84-Year-Old Patient

No additional pneumococcal vaccine is needed for this 84-year-old patient in October 2025 based on the current Advisory Committee on Immunization Practices (ACIP) recommendations. 1

Patient's Current Vaccination Status

• Patient is 84 years old
• Received PCV13 in 2015
• Received PPSV23 in August 2022
• Current question is about need for vaccination in October 2025

Rationale for Recommendation

Complete Vaccination Series

• The patient has already received both PCV13 and PPSV23, which constitutes a complete pneumococcal vaccination series for adults ≥65 years under previous and current guidelines 1
• For adults who have received both PCV13 and PPSV23 (with PPSV23 administered at age ≥65 years), no additional routine pneumococcal vaccination is recommended 1

Timing Considerations

• The patient received PPSV23 in 2022, which is the most recent vaccine
• Current ACIP guidelines do not recommend routine revaccination with PPSV23 after the dose administered at age ≥65 years 1
• The patient's vaccination sequence (PCV13 followed by PPSV23) is considered optimal for immune response 2

Updated Guidelines Considerations

• The 2023 ACIP guidelines provide options for adults who have already received both PCV13 and PPSV23:
  • No additional vaccines are recommended at this time 1
  • Shared clinical decision-making could be considered for PCV20 or PCV21 administration ≥5 years after the last pneumococcal vaccine dose, but this is not routinely recommended 1

Special Considerations

Age-Related Factors

• Adults ≥65 years who have received a complete pneumococcal vaccination series have demonstrated protection against pneumococcal disease 3
• Sequential vaccination with PCV13 followed by PPSV23 (as this patient received) has shown better effectiveness in preventing pneumococcal community-acquired pneumonia compared to single-dose vaccination, particularly in adults aged 65-74 years 4

Potential Risks of Revaccination

• Unnecessary revaccination may increase the risk of adverse reactions 5
• National coverage for pneumococcal vaccination among adults ≥65 years remains below target levels (60.1% vs. target of 90%), suggesting focus should be on unvaccinated individuals rather than revaccination of those who completed the series 6

Future Considerations

• If new pneumococcal vaccines with broader serotype coverage become standard of care with new recommendations, the patient's vaccination status should be reassessed 1, 7
• The most recent 2024 ACIP guidance suggests that for adults who have completed the recommended vaccination series with both PCV13 and PPSV23, shared clinical decision-making could be considered for a single dose of PCV21 or PCV20 ≥5 years after the last pneumococcal vaccine dose 1
• Since the patient received PPSV23 in 2022, even under the newest guidelines, October 2025 would be too early for consideration of additional vaccination (would need to wait until at least 2027) 1