Does a patient who received Pneumovax-23 (Pneumococcal Polysaccharide Vaccine, PPV23) on August 20, 2020, and PCV13 (Pneumococcal Conjugate Vaccine) on March 29, 2019, need a pneumococcal booster?

Pneumococcal Vaccination Recommendation for Patient with Prior PCV13 and PPV23

Based on the 2023 Advisory Committee on Immunization Practices (ACIP) recommendations, this patient who received PCV13 on March 29,2019, and PPV23 on August 20,2020, does not need a pneumococcal booster at this time.

Assessment of Current Vaccination Status

• The patient has already received both PCV13 (March 2019) and PPV23 (August 2020) in the recommended sequence (PCV13 followed by PPV23) 1
• The interval between the two vaccines (approximately 17 months) exceeds the minimum recommended interval of ≥1 year for immunocompetent adults or ≥8 weeks for immunocompromised adults 1, 2
• According to the 2023 ACIP guidelines, adults who have received both PCV13 and PPV23 do not require additional pneumococcal vaccination until they reach age 65 (if not already 65+) 1

Specific Recommendations Based on Age and Risk Factors

• For adults aged 19-64 years with chronic medical conditions who have received both PCV13 and PPV23, no additional pneumococcal vaccine dose is indicated 1
• The pneumococcal vaccination recommendations should be reassessed when the patient turns 65 years of age 1
• If the patient is already ≥65 years and has received both vaccines with the second dose (PPV23) administered at age ≥65 years, the vaccination series is considered complete 1

Special Considerations

• If the patient has certain immunocompromising conditions (such as congenital or acquired asplenia, immunodeficiency, HIV, hematologic malignancies, or solid organ transplant), their vaccination status should be reviewed at age 65 to determine if an additional dose is needed 1
• For patients who received HSCT (hematopoietic stem cell transplantation), a different vaccination schedule applies, requiring multiple doses of PCV20 1
• The ACIP does not recommend routine revaccination with PPSV23 for immunocompetent persons who have been previously vaccinated 3

Future Recommendations

• When the patient reaches age 65 (if not already there), the pneumococcal vaccine recommendations should be reviewed again 1
• Shared clinical decision-making is recommended regarding PCV20 use for adults aged ≥65 years who have completed the recommended vaccine series with both PCV13 and PPSV23 (with PPSV23 administered at age ≥65 years) 1
• The current evidence does not support routine revaccination with pneumococcal vaccines for immunocompetent individuals who have completed the recommended series 3, 4

Common Pitfalls to Avoid

• Unnecessarily revaccinating patients who have already completed their recommended pneumococcal vaccination series can lead to increased local reactions 4
• Failing to reassess pneumococcal vaccination status when patients turn 65 years old 1
• Not recognizing that recommendations differ based on age, risk factors, and prior vaccination history 1
• Overlooking that the timing between PCV13 and PPSV23 in this patient's case (17 months) was appropriate and meets current guidelines 2