Recommended Pneumococcal and Influenza Vaccine Dosage Schedules
For adults, the recommended pneumococcal vaccination is a single dose of PCV20, which provides comprehensive protection against pneumococcal disease without requiring additional PPSV23 vaccination in most cases. 1
Pneumococcal Vaccine Recommendations for Adults
Adults ≥65 years of age
- For those with no previous pneumococcal vaccination: Administer a single dose of PCV20 1, 2
- For those previously vaccinated with PPSV23 only: Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2
- Alternative schedule if PCV20 is unavailable: Administer PCV15, followed by PPSV23 at least 1 year later 3
Adults 19-64 years with immunocompromising conditions
- For those with no previous pneumococcal vaccination: Administer a single dose of PCV20 3
- For those previously vaccinated with PPSV23 only: Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 3
- For those previously vaccinated with PCV13 only: Administer a single dose of PCV20 at least 1 year after the last PCV13 dose 3
- Alternative schedule if PCV20 is unavailable: Administer PCV15, then PPSV23 at least 8 weeks later 3
Adults 19-64 years with chronic medical conditions
- For those with no previous pneumococcal vaccination: Administer a single dose of PCV20 3, 1
- For those previously vaccinated with PPSV23 only: Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 3, 1
- For those previously vaccinated with PCV13 only: Administer a single dose of PCV20 at least 1 year after the last PCV13 dose 3
Special population: Hematopoietic Stem Cell Transplant (HSCT) recipients
- Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth PCV20 dose at least 6 months after the third dose or at least 12 months after HSCT, whichever is later 1, 2
Influenza Vaccine Recommendations
Adults ≥9 years
- Administer one 0.5 mL dose annually 4
Children 6 months through 8 years
- If not previously vaccinated or unknown vaccination history: Two 0.5 mL doses administered at least 4 weeks apart 4
- If previously vaccinated: One or two 0.5 mL doses (based on ACIP recommendations) 4
Children 6 months through 35 months
- If not previously vaccinated or unknown vaccination history: Two doses (either 0.25 mL or 0.5 mL) administered at least 4 weeks apart 4
- If previously vaccinated: One or two doses (either 0.25 mL or 0.5 mL) 4
Important Clinical Considerations
Timing of vaccination
- Pneumococcal and influenza vaccines can be administered at the same visit at different anatomic sites 1
- For patients who have received PCV15 but have not completed their series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available 1, 2
Common pitfalls to avoid
- Failing to check the patient's prior pneumococcal vaccination history can lead to incorrect vaccination schedules 1, 2
- Not waiting the recommended interval between different pneumococcal vaccines (typically ≥1 year after PCV13 or ≥1 year after PPSV23) 1, 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
Special considerations for high-risk individuals
- Adults with asplenia, complement deficiencies, or who work in outbreak settings are considered at increased risk for meningococcal disease and should receive appropriate meningococcal vaccination 3
- Immunocompromised individuals may have a diminished immune response to vaccination 4
- Recent evidence suggests that prior PPSV23 vaccination may diminish the response to subsequent PCV13 administration 5