What is the vaccine schedule for pneumococcal (PCV13 and PPSV23), shingles (Shingrix, generic name zoster vaccine recombinant) and Hepatitis A (HEPA) vaccines?

Vaccine Schedule for Pneumococcal, Shingles, and Hepatitis A Vaccines

For optimal protection against pneumococcal disease, shingles, and hepatitis A, adults should follow the current ACIP recommendations which include a single dose of PCV20 for pneumococcal disease, two doses of Shingrix for shingles, and a two-dose series for hepatitis A.

Pneumococcal Vaccine Schedule

Adults aged ≥65 years:

• Option A (preferred): Administer a single dose of PCV20 1, 2
• Option B: Administer a single dose of PCV15, followed by a dose of PPSV23 at least 1 year later 1

Adults aged 19-64 years with immunocompromising conditions:

• Option A (preferred): Administer a single dose of PCV20 1, 2
• Option B: Administer a single dose of PCV15, followed by a dose of PPSV23 at least 8 weeks later 1

Adults aged 19-64 years with chronic medical conditions:

• Option A (preferred): Administer a single dose of PCV20 1, 2
• Option B: Administer a single dose of PCV15, followed by a dose of PPSV23 at least 1 year later 1

For adults with prior pneumococcal vaccination:

• If previously received PPSV23 only: Administer PCV20 at least 1 year after the last PPSV23 dose 1
• If previously received PCV13 only: Administer PCV20 at least 1 year after the PCV13 dose 1
• If previously received both PCV13 and PPSV23: No additional pneumococcal vaccination needed until age 65 years 1

Shingles (Zoster) Vaccine Schedule

• Shingrix (recombinant zoster vaccine): Administer 2 doses, 2-6 months apart, for adults aged ≥50 years 3
• Shingrix is recommended for all adults aged ≥50 years, regardless of prior history of herpes zoster or receipt of Zostavax 3
• For immunocompromised adults aged ≥18 years, including those who received an autologous hematopoietic stem cell transplant, Shingrix is also recommended as a 2-dose series 3
• If previously vaccinated with Zostavax, wait at least 5 years before administering Shingrix 3

Hepatitis A Vaccine Schedule

• Standard schedule: Administer 2 doses of single-antigen hepatitis A vaccine:
  • Havrix: 0 and 6-12 months 1
  • Vaqta: 0 and 6-18 months 1
• Alternative schedule (combined hepatitis A and B vaccine - Twinrix):
  • Standard 3-dose schedule: 0,1, and 6 months 1
  • Accelerated 4-dose schedule: days 0,7,21-30, followed by a booster at 12 months 1

Special Considerations

Pneumococcal Vaccine:

• PCV20 has simplified the pneumococcal vaccination schedule by providing broader serotype coverage in a single dose 2
• For adults with hematopoietic stem cell transplant: Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after transplant, followed by a fourth dose ≥6 months after the third dose 1
• Pneumococcal vaccines should be administered at least 2 weeks before elective splenectomy or initiation of immunosuppressive therapy 1

Shingrix:

• Shingrix demonstrates high efficacy (>90%) against herpes zoster in adults aged ≥50 years and 68.2% efficacy in immunocompromised adults 3
• Shingrix can be administered concomitantly with influenza vaccine, pneumococcal vaccines, and Tdap without interference in immune response 3
• Completing the 2-dose series is essential for optimal protection; a single dose provides incomplete protection 3

Hepatitis A:

• Recommended for adults with specific risk factors: men who have sex with men, injection drug users, persons with chronic liver disease, travelers to endemic areas, and those in close contact with international adoptees 1
• For international adoption situations, the first dose should be administered as soon as adoption is planned, ideally ≥2 weeks before the adoptee's arrival 1

Common Pitfalls to Avoid

• Don't use outdated pneumococcal vaccine schedules: The 2023 ACIP recommendations have simplified the approach by recommending PCV20 as a preferred single-dose option 1, 2
• Don't miss the second dose of Shingrix: Efficacy data is based on the complete 2-dose series; schedule the second dose at the time the first dose is administered 3
• Don't confuse intervals between pneumococcal vaccines: For immunocompromised adults, the interval between PCV15 and PPSV23 is at least 8 weeks, while for immunocompetent adults, it's at least 1 year 1, 4
• Don't administer pneumococcal vaccines during chemotherapy or radiation therapy: Optimal timing is at least 2 weeks before starting immunosuppressive therapy 1