Pneumococcal Vaccination Recommendations
For adults aged ≥19 years, pneumococcal vaccination is recommended as a single dose of PCV20 alone or a single dose of PCV15 followed by PPSV23, with no routine revaccination needed except in specific high-risk populations. 1
General Recommendations by Age Group
Adults aged ≥65 years:
- For pneumococcal vaccine-naïve adults: Administer a single dose of PCV20 alone OR a single dose of PCV15 followed by PPSV23 ≥1 year later 1
- For those who previously received PPSV23 only: Administer a single dose of PCV20 ≥1 year after the last PPSV23 dose 1, 2
- For those who previously received PCV13 only: Administer a single dose of PCV20 ≥1 year after PCV13 OR a single dose of PPSV23 ≥1 year after PCV13 1
- For those who received both PCV13 and PPSV23 previously: No additional routine vaccination is needed unless they have specific high-risk conditions 1
Adults aged 19-64 years:
- Routine pneumococcal vaccination is recommended only for those with specific medical conditions 1
- For those with chronic medical conditions (heart disease, lung disease, liver disease, diabetes, alcoholism, or cigarette smoking): A single dose of PCV20 alone OR PCV15 followed by PPSV23 ≥1 year later 1
Special Populations with Higher Risk
Immunocompromised adults, those with CSF leaks, or cochlear implants:
- For pneumococcal vaccine-naïve adults: A single dose of PCV20 alone OR PCV15 followed by PPSV23 ≥8 weeks later (shorter interval than non-immunocompromised) 1
- For those who previously received PPSV23 only: A single dose of PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1
- For those who previously received PCV13 only: A single dose of PCV20 ≥1 year after PCV13 OR PPSV23 ≥8 weeks after PCV13 1
Hematopoietic Stem Cell Transplant (HSCT) recipients:
- Require a specialized schedule: 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
- If PCV20 is unavailable, administer 3 doses of PCV15 4 weeks apart, followed by a single dose of PPSV23 ≥1 year after HSCT 1
Important Clinical Considerations
Timing between different pneumococcal vaccines:
- PCV20 after PPSV23: Wait ≥1 year 1, 2
- PCV20 after PCV13: Wait ≥1 year 1
- PPSV23 after PCV15 in immunocompetent adults: Wait ≥1 year 1
- PPSV23 after PCV15 in immunocompromised adults: Wait ≥8 weeks 1
Revaccination considerations:
- Most adults need only a single lifetime sequence of pneumococcal vaccines 1
- Adults who received pneumococcal vaccination before age 65 generally do not need revaccination once they reach age 65 1
- Immunocompromised adults who received PPSV23 before age 65 should receive another dose of PPSV23 at age ≥65 years, ≥5 years after their previous PPSV23 dose 1
Recent Updates to Recommendations
- As of 2023-2024, PCV20 or PCV21 are preferred over the PCV15+PPSV23 series due to simplified administration and comparable protection 1, 3
- The 2019 recommendation for routine PCV13 for all adults aged ≥65 years was discontinued; now PCV20 is the preferred pneumococcal conjugate vaccine 1
- Initial vaccination with PCV (conjugate vaccine) establishes better immune memory than PPSV23 (polysaccharide vaccine), resulting in stronger responses to subsequent vaccinations 4
Common Pitfalls to Avoid
- Failing to check the patient's prior pneumococcal vaccination history, which determines the appropriate timing and type of vaccine 2
- Administering pneumococcal vaccines too close together, which may result in reduced immune response 2, 4
- Revaccinating unnecessarily when a complete series has already been administered 1
- Not recognizing that immunocompromised patients need shorter intervals between PCV15 and PPSV23 (≥8 weeks) compared to immunocompetent patients (≥1 year) 1