Pneumococcal Vaccine Indications
The pneumococcal vaccine is indicated for all adults aged ≥65 years and for persons aged 2-64 years with specific risk factors including chronic illnesses, immunocompromising conditions, anatomic or functional asplenia, and certain environmental or social settings that increase risk of pneumococcal disease. 1
Indications by Age Group
Adults ≥65 Years
- All adults aged 65 years and older should receive pneumococcal vaccination regardless of previous vaccination history or health status 1
- For adults ≥65 years with unknown vaccination status, a single dose of vaccine is recommended 1
- Current recommendations include either a single dose of PCV20 alone or a dose of PCV15 followed by PPSV23 at least 1 year later 1, 2
Persons Aged 2-64 Years with Chronic Medical Conditions
Pneumococcal vaccination is indicated for individuals with:
- Chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies) 1
- Chronic pulmonary disease (e.g., COPD, emphysema, asthma) 1
- Diabetes mellitus 1
- Alcoholism 1
- Chronic liver disease (cirrhosis) 1
- Cerebrospinal fluid (CSF) leaks 1
- Cigarette smoking 1
- Cochlear implants 1
Persons Aged 2-64 Years with Immunocompromising Conditions
Vaccination is strongly recommended for:
- HIV infection (symptomatic or asymptomatic) 1
- Functional or anatomic asplenia (e.g., sickle cell disease, splenectomy) 1
- Leukemia, lymphoma, Hodgkin disease 1
- Multiple myeloma 1
- Generalized malignancy 1
- Chronic renal failure 1
- Nephrotic syndrome 1
- Organ or bone marrow transplantation 1
- Immunosuppressive therapy recipients (including long-term systemic corticosteroids) 1
- Congenital or acquired immunodeficiencies 1
Special Populations and Settings
- Residents of nursing homes and long-term care facilities 1
- Certain populations with increased risk (e.g., Alaskan Natives, certain American Indian populations) 1
Timing Considerations
- For elective splenectomy, pneumococcal vaccine should be administered at least 2 weeks before surgery 1
- For patients undergoing immunosuppressive therapy, vaccination should occur at least 2 weeks before initiation of therapy 1
- Vaccination during chemotherapy or radiation therapy should be avoided 1
- For hematopoietic stem cell transplant recipients, specific vaccination schedules are recommended, starting 3-6 months after transplant 1
Important Clinical Considerations
- Despite recommendations, pneumococcal vaccination rates remain suboptimal, particularly in adults aged 18-64 years with underlying medical conditions 3
- Immunosenescence in older adults results in similar disease risk as younger adults with immunocompromising conditions, supporting the recommendation for universal vaccination in those ≥65 years 4
- The vaccine is less effective in immunocompromised patients compared to immunocompetent persons, but the potential benefits and safety justify its use 1
- Pneumococcal vaccine can be administered concurrently with influenza vaccine (at separate injection sites) without increased side effects or decreased antibody response 1
- Asplenic patients should be informed that vaccination does not guarantee protection against fulminant pneumococcal disease, which has a case-fatality rate of 50-80% 1
Common Pitfalls to Avoid
- Not recognizing asthma as an indication for pneumococcal vaccination - current guidelines include asthma as a chronic lung disease warranting vaccination 1
- Failing to vaccinate patients with HIV infection as soon as possible after diagnosis confirmation 1
- Missing opportunities to vaccinate during routine healthcare visits, particularly in adults aged 50-64 years with risk factors 1
- Not assessing vaccination status during the adolescent immunization visit at 11-12 years of age 1
- Assuming that recurrent upper respiratory tract diseases, otitis media, or sinusitis are indications for pneumococcal vaccine (they are not specific indications) 1