What is the recommended pneumococcal vaccination schedule for a 68-year-old female?

Pneumococcal Vaccination Recommendations for a 68-Year-Old Female

For a 68-year-old female with no previous pneumococcal vaccination, a single dose of PCV20 (20-valent pneumococcal conjugate vaccine) is recommended as the preferred option. 1

Current ACIP Recommendations for Adults ≥65 Years

• For adults aged ≥65 years who have never received a pneumococcal vaccine, there are two recommended options:

  • Option A: A single dose of PCV20 1
  • Option B: A single dose of PCV15 followed by a dose of PPSV23 at least 1 year later 1

• The 2023-2024 ACIP guidelines have updated the pneumococcal vaccination recommendations to include newer conjugate vaccines (PCV15, PCV20, and most recently PCV21) which provide broader serotype coverage 1

• PCV20 is FDA-approved for the prevention of invasive pneumococcal disease and pneumonia caused by 20 Streptococcus pneumoniae serotypes in adults 2

Vaccination Schedule Based on Prior Vaccination Status

• If the patient has never received any pneumococcal vaccine:

  • Administer a single dose of PCV20 (preferred option for simplicity) 1
  • Alternatively, administer PCV15 followed by PPSV23 at least 1 year later 1

• If the patient previously received PPSV23 before age 65:

  • Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1
  • If using PCV15, administer it at least 1 year after the last PPSV23 dose 1

• If the patient previously received PCV13:

  • Administer a single dose of PCV20 or PPSV23 at least 1 year after the PCV13 dose 1

Special Considerations

• For immunocompromised adults or those with cerebrospinal fluid leaks or cochlear implants, the vaccination schedule is more aggressive with shorter intervals between doses 1

• PCV13 is no longer routinely recommended for all adults aged ≥65 years since 2019, as it has been replaced by newer pneumococcal conjugate vaccines with broader coverage 1

• The PPSV23 vaccine contains 11 additional serotypes not included in PCV13, which account for 32-37% of invasive pneumococcal disease among adults aged ≥65 years 1

Implementation Guidance

• Pneumococcal vaccines should not be co-administered with each other 1

• If both PCV20 and PPSV23 are to be administered in sequence, PCV20 should be administered first to optimize immune response 3

• Prior PPSV23 vaccination can impair the immune response to subsequent PCV administration, which is why the recommended interval between PPSV23 and subsequent PCV is at least 1 year 3

• A 1-year interval between sequential pneumococcal vaccines provides better booster effects than shorter intervals 4

Potential Pitfalls to Avoid

• Avoid administering PPSV23 before PCV in sequential vaccination, as this can diminish the immune response to the subsequent PCV dose 5, 3

• Do not administer pneumococcal vaccines to individuals with severe allergic reactions to any vaccine component or to diphtheria toxoid 2

• Avoid unnecessary revaccination with PPSV23 after the dose administered at age ≥65 years, as no additional doses are recommended 1, 6

• Remember that PCV and PPSV23 should not be coadministered on the same day 1

By following these recommendations, the 68-year-old female will receive optimal protection against pneumococcal disease, reducing her risk of invasive pneumococcal disease and pneumonia.