What is the current recommended pneumonia vaccine schedule for individuals 65 and older?

Current Pneumococcal Vaccination Recommendations for Adults 65 and Older

For adults aged ≥65 years who have never received a pneumococcal vaccine, the recommended option is a single dose of PCV20 (20-valent pneumococcal conjugate vaccine). 1

Current ACIP Recommendations (2023-2025)

• All adults aged ≥65 years should receive pneumococcal vaccination, with the preferred option being a single dose of PCV20 1
• An alternative option is to administer a single dose of PCV15 followed by a dose of PPSV23 at least 1 year later 1
• The previous recommendation for routine PCV13 use among all adults aged ≥65 years was removed in 2019 and replaced with a shared clinical decision-making approach 2

Vaccination Schedule Based on Prior Vaccination Status

For pneumococcal vaccine-naïve adults ≥65 years:

• Administer a single dose of PCV20 (preferred for simplicity) 1
• OR administer PCV15 followed by PPSV23 at least 1 year later 1

For adults ≥65 years with prior vaccination:

• If previously received PPSV23: Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1
• If previously received PCV13: Administer a single dose of PCV20 or PPSV23 at least 1 year after the PCV13 dose 1
• If previously received both PCV13 and PPSV23: No additional vaccination is needed 2

Special Considerations

• Adults ≥65 years with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants should receive PCV20 (or PCV15 followed by PPSV23) regardless of previous pneumococcal vaccination history 2
• For these high-risk individuals, if PCV15 is used, PPSV23 should be administered at least 8 weeks later rather than waiting a full year 2
• Individuals residing in nursing homes, long-term care facilities, or settings with low pediatric PCV13 uptake may benefit more from vaccination 2

Timing Considerations

• If administering both PCV and PPSV23, maintain the recommended intervals:
  • For immunocompetent adults: Give PPSV23 at least 1 year after PCV 2
  • For immunocompromised adults: Give PPSV23 at least 8 weeks after PCV 2
• Pneumococcal vaccines should not be co-administered with each other on the same day 1
• No additional doses of PPSV23 should be administered following the dose given at age ≥65 years 2

Rationale for Current Recommendations

• The 2019 change from routine PCV13 recommendation to shared decision-making was based on evidence that indirect effects from pediatric PCV13 use had already reduced disease burden in adults 2
• Economic analyses showed less favorable cost-effectiveness for continued routine PCV13 use in all adults ≥65 years ($200,000-$560,000 per QALY) compared to previous estimates ($65,000 per QALY in 2014) 2
• Newer conjugate vaccines (PCV15, PCV20, PCV21) provide broader serotype coverage than the earlier PCV13 1, 3
• Recent evidence supports that PCV20 is safe and effective in preventing pneumococcal disease in older adults 4

Effectiveness Considerations

• In adults aged 65-74 years, sequential PCV13/PPSV23 vaccination showed the highest adjusted vaccine effectiveness (80.3%) against pneumococcal community-acquired pneumonia in a recent study 5
• PCV vaccines generally produce better immune responses than PPSV23, particularly in older adults 6
• A prior dose of PPSV23 may diminish the immune response to subsequent PCV administration 6

By following these updated recommendations, healthcare providers can optimize protection against pneumococcal disease in adults aged ≥65 years while considering their vaccination history and risk factors.