Pneumococcal Vaccine (PCV13 and PPSV23) Indications
PPSV23 is recommended for all adults aged ≥65 years, while PCV13 is now recommended based on shared clinical decision-making for most adults ≥65 years, with specific indications for certain high-risk groups regardless of age. 1
General Recommendations by Age Group
Adults ≥65 years:
- PPSV23: All adults aged ≥65 years should receive one dose of PPSV23, regardless of previous vaccination history or medical conditions 1
- PCV13: No longer routinely recommended for all adults ≥65 years; instead, shared clinical decision-making is recommended for those without immunocompromising conditions, CSF leaks, or cochlear implants 1
- If PCV13 is administered, it should be given before PPSV23 with at least a 1-year interval between vaccines 1, 2
- Adults who received PPSV23 before age 65 should receive one additional dose of PPSV23 at age ≥65 years, at least 5 years after the previous dose 1
Adults 19-64 years:
- PCV13 is recommended for adults aged ≥19 years with specific high-risk conditions (see below) 1
- PPSV23 is recommended for adults aged 19-64 years with certain medical conditions 1
Specific Indications by Medical Condition
Immunocompromised persons (all ages):
PCV13 followed by PPSV23 is recommended for adults with: 1
- Congenital or acquired asplenia
- Sickle cell disease/hemoglobinopathies
- Chronic renal failure
- Congenital or acquired immunodeficiencies
- HIV infection
- Generalized malignancy
- Hodgkin disease, leukemia, lymphoma, multiple myeloma
- Iatrogenic immunosuppression (including long-term corticosteroids)
- Solid organ transplant
- Nephrotic syndrome
Vaccination schedule for immunocompromised adults: 1
- PCV13: 1 dose
- PPSV23: 2 doses, with first dose ≥8 weeks after PCV13
- For those ≥65 years: Additional PPSV23 dose ≥5 years after any previous PPSV23 dose received before age 65
Specific high-risk conditions requiring both vaccines:
- CSF leaks: PCV13 followed by PPSV23 (≥8 weeks later) 1
- Cochlear implants: PCV13 followed by PPSV23 (≥8 weeks later) 1
Immunocompetent persons with chronic conditions (19-64 years):
- PPSV23 only (1 dose) is recommended for adults aged 19-64 years with: 1
- Alcoholism
- Chronic heart disease (including congestive heart failure and cardiomyopathies)
- Chronic liver disease
- Chronic lung disease (including COPD, emphysema, and asthma)
- Cigarette smoking
- Diabetes mellitus
Timing and Administration Considerations
- PCV13 and PPSV23 should not be coadministered 1, 2
- For adults with immunocompromising conditions, CSF leaks, or cochlear implants: 1, 2
- Give PCV13 first, then PPSV23 ≥8 weeks later
- For immunocompetent adults ≥65 years (if PCV13 is given): 1, 2
- Give PCV13 first, then PPSV23 ≥1 year later
- For adults who previously received PPSV23: 1
- Give PCV13 ≥1 year after the most recent PPSV23 dose
Shared Clinical Decision-Making for PCV13 in Adults ≥65 Years
When considering PCV13 for adults ≥65 years without high-risk conditions, providers should discuss: 1
- Individual's risk for exposure to PCV13 serotypes
- Risk for pneumococcal disease based on underlying medical conditions
- PCV13 safety profile and ability to prevent pneumococcal disease
Important Considerations
- The recommendation for PCV13 changed in 2019 due to reduced incidence of PCV13-type disease through indirect effects from pediatric vaccination 1
- PPSV23 contains 11 additional serotypes not in PCV13, which account for 32-37% of invasive pneumococcal disease among adults ≥65 years 1
- Newer pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) have been introduced since these guidelines and may offer additional serotype coverage 3