Standard Pneumococcal Vaccination Guidelines
The current standard pneumococcal vaccination recommendation for adults aged ≥19 years is to administer a single dose of 20-valent pneumococcal conjugate vaccine (PCV20) for those who have not previously received a pneumococcal vaccine or whose vaccination history is unknown. 1, 2
General Adult Recommendations (Age ≥19 years)
Adults aged ≥65 years:
- For those with no previous pneumococcal vaccination: Administer a single dose of PCV20 1, 2
- For those who previously received PPSV23 only: Administer a single dose of PCV20 at least 1 year after 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
Adults aged 19-64 years:
- For those with immunocompromising conditions, CSF leaks, or cochlear implants who have not received a pneumococcal vaccine: Administer a single dose of PCV20 1, 2
- Alternative schedule if PCV20 is not available: Administer PCV15 followed by PPSV23 after ≥8 weeks for immunocompromised individuals or ≥1 year for non-immunocompromised individuals 1
Special Populations
Immunocompromised individuals:
- Patients with rheumatic and musculoskeletal diseases taking immunosuppressive medication: Pneumococcal vaccination is strongly recommended 1
- The CDC currently recommends either PCV20 alone or PCV15 followed by PPSV23 for adults with immunocompromising conditions 1
Hematopoietic stem cell transplant recipients:
- Recommended to receive 4 doses of PCV20, starting 3-6 months after HSCT 1, 2
- Administer 3 doses of PCV20, 4 weeks apart, followed by a fourth dose ≥6 months after the third dose or ≥12 months after HSCT, whichever is later 1
Pediatric Recommendations
Children aged <19 years:
- PCV15 has been approved as an option for pneumococcal conjugate vaccination according to currently recommended PCV13 dosing and schedules 3
- For children aged 2-18 years with underlying medical conditions that increase risk for pneumococcal disease, PPSV23 is still recommended 3
Children with primary complement deficiencies:
- Aged 2-5 years: Should receive 1 dose of PCV13 if they have received 3 doses of PCV before age 24 months; or 2 doses of PCV13 (8 weeks apart) if they have received an incomplete schedule of ≤2 doses of PCV before age 24 months 1
- Aged 6-18 years with classic pathway, alternate pathway, or severe mannan-binding lectin deficiency who have not received PCV13: Should receive a single dose of PCV13 1
Important Clinical Considerations
- PCV20 can be administered at the same visit as other age-appropriate vaccines at different anatomic sites 2
- For patients who have received PCV15 but have not completed their recommended pneumococcal vaccine series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available 2
- A single dose of PCV provides protection against vaccine-type invasive pneumococcal disease, especially when administered after age 12 months 4
Common Pitfalls to Avoid
- Failing to check the patient's prior pneumococcal vaccination history can lead to unnecessary doses or incorrect vaccination schedules 2
- Withholding vaccination in the absence of an immunization record is not recommended; the patient's verbal history should be used to determine prior vaccination status 2
- Not completing the vaccination cycle - studies show that recommended time points for vaccination are often not met in children 5
Revaccination Considerations
- High-risk individuals, such as those with functional or anatomic asplenia, HIV infection, or other immunosuppressive conditions, should receive revaccination once if 5 years have elapsed since the first dose 2
- Revaccination is contraindicated for persons who had a severe reaction to the initial dose 2