Pneumococcal Vaccination Schedule for Adults at Increased Risk of Pneumococcal Disease
For adults at increased risk of pneumococcal disease, the recommended vaccination schedule is a single dose of PCV21, PCV20, or PCV15 followed by PPSV23 (if PCV15 is used) with specific timing based on risk factors. 1
Current Pneumococcal Vaccine Options
- Four pneumococcal vaccines are currently licensed for use in adults in the United States: 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), 15-valent pneumococcal conjugate vaccine (PCV15), 20-valent pneumococcal conjugate vaccine (PCV20), and 21-valent pneumococcal conjugate vaccine (PCV21) 1
- The newest option, PCV21 (CAPVAXIVE), contains eight pneumococcal serotypes not included in previously recommended vaccines 1
Vaccination Schedule for Adults with Immunocompromising Conditions
- For adults with immunocompromising conditions (including congenital or acquired asplenia, sickle cell disease, chronic renal failure, and HIV infection), administer a single dose of PCV21, PCV20, or PCV15 2, 1
- If PCV15 is used, follow with PPSV23 at least 8 weeks later 2, 1, 3
- If PCV20 or PCV21 is used, no additional dose of PPSV23 is needed 1, 3
Vaccination Schedule for Adults with CSF Leaks or Cochlear Implants
- For adults with cerebrospinal fluid leaks or cochlear implants, administer PCV21, PCV20, or PCV15 2, 1
- If PCV15 is used, follow with PPSV23 at least 8 weeks later 2, 3
- If PCV20 or PCV21 is used, no additional dose of PPSV23 is needed 1, 3
Vaccination Schedule for Adults with Chronic Medical Conditions
- For adults with chronic medical conditions (such as alcoholism, chronic heart/liver/lung disease, cigarette smoking, and diabetes), administer a single dose of PCV21, PCV20, or PCV15 1, 3
- If PCV15 is used, follow with PPSV23 at least 1 year later 1, 3
- If PCV20 or PCV21 is used, no additional dose of PPSV23 is needed 1, 3
Vaccination Schedule Based on Prior Vaccination History
- For adults with no prior pneumococcal vaccination, administer a single dose of PCV21, PCV20, or PCV15 (with PPSV23 to follow if PCV15 is used) 1, 3
- For adults who previously received PPSV23 only, administer a single dose of PCV21, PCV20, or PCV15 at least 1 year after the last PPSV23 dose 1, 3
- For adults who previously received PCV13 only, administer a single dose of PCV21, PCV20, or PPSV23 at least 1 year after the PCV13 dose 1, 3
Important Considerations and Caveats
- PCV and PPSV23 should not be administered during the same visit 2, 3
- When both are indicated, PCV should always be administered before PPSV23 3
- The minimum interval between PCV15 and PPSV23 is 8 weeks for immunocompromised adults and at least 1 year for immunocompetent adults 1, 3
- Adults who received PPSV23 before age 65 should receive one additional dose of PPSV23 at age ≥65 years, at least 5 years after the previous dose 2, 3
- Initial vaccination with PPSV23 may result in lower responses to subsequent PPSV23 administration compared to initial responses, while PCV13 establishes an immune state that results in recall responses upon subsequent vaccination 4
Special Populations
- For hematopoietic stem cell transplant (HSCT) recipients, administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth dose ≥6 months after the third dose 3
- If PCV20 is unavailable for HSCT recipients, give 3 doses of PCV15 followed by PPSV23 ≥1 year after HSCT 3
- Adults residing in nursing homes or long-term care facilities may benefit more from PCV vaccination 1
Common Pitfalls to Avoid
- Failing to assess vaccination history before administering pneumococcal vaccines 3
- Administering PCV and PPSV23 at the same visit (they should be separated) 2, 3
- Not waiting the appropriate interval between different pneumococcal vaccines 3
- Overlooking the need for revaccination with PPSV23 in adults ≥65 years who received PPSV23 before age 65 3