Pneumococcal Vaccine Recommendations for Adults
For adults aged ≥65 years and adults aged 19-64 years with certain medical conditions, the CDC recommends a single dose of PCV20 alone or PCV15 followed by PPSV23. 1, 2
General Recommendations by Age Group
Adults ≥65 years:
- Option A: Administer a single dose of PCV20 1
- Option B: Administer a single dose of PCV15, followed by PPSV23 ≥1 year later 1
- For those who previously received PPSV23, administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1, 2
- For those who previously received PCV13 only, administer PCV20 after ≥1 year interval or PPSV23 after ≥1 year interval 1
- For those who received both PCV13 and PPSV23 but not yet PPSV23 at age ≥65 years, administer PCV20 after ≥5 years from last dose or PPSV23 after appropriate intervals 1
Adults 19-64 years with chronic medical conditions:
- Chronic conditions include: alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus 1
- Option A: Administer a single dose of PCV20 1, 2
- Option B: Administer a single dose of PCV15, followed by PPSV23 ≥1 year later 1
- For those who previously received PPSV23, administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1
Adults 19-64 years with immunocompromising conditions, CSF leaks, or cochlear implants:
- Immunocompromising conditions include: chronic renal failure, asplenia, immunodeficiencies, HIV, malignancies, immunosuppressive therapy, etc. 1
- Option A: Administer a single dose of PCV20 1, 2
- Option B: Administer a single dose of PCV15, followed by PPSV23 ≥8 weeks later 1
- For those who previously received PPSV23, administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1
Special Populations
Hematopoietic Stem Cell Transplant (HSCT) Recipients:
- Option A: Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth PCV20 dose ≥6 months after the third dose or ≥12 months after HSCT, whichever is later 1, 2
- Option B: Administer 3 doses of PCV15, 4 weeks apart starting 3-6 months after HSCT, followed by PPSV23 ≥12 months after HSCT if no chronic GVHD; if chronic GVHD present, administer a fourth dose of PCV15 instead of PPSV23 1
Important Clinical Considerations
- Always check the patient's prior pneumococcal vaccination history before administering any pneumococcal vaccine 2
- 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 not completed their series with PPSV23, one dose of PCV20 may be used if PPSV23 is not available 2
- The 2021-2022 recommendations represent a significant simplification of previous pneumococcal vaccination guidelines 3
- Prior PPSV23 vaccination may diminish the immune response to subsequent PCV13 administration, suggesting the benefit of using PCV20 as a single-dose option 4
- Post-acute and long-term care facilities are required to assess pneumococcal vaccination status, provide education, and administer appropriate vaccines 5
Pitfalls to Avoid
- Failing to wait the recommended interval between different pneumococcal vaccines (typically ≥1 year after PCV13 or ≥1 year after PPSV23) 2, 6
- Not following the special dosing schedule required for HSCT recipients 1, 2
- Overlooking the need for pneumococcal vaccination in adults aged 19-64 years with chronic medical conditions 1, 7
- Failing to revaccinate adults who received PPSV23 before age 65 with an additional dose at age ≥65 years (at least 5 years after previous dose) 8