Is a 68-year-old patient with diabetes due for additional pneumococcal (pneumonia) vaccines after receiving Pneumovax 23 (PPV23) on 12/7/15 and 12/18/20?

Pneumococcal Vaccination Recommendations for a 68-Year-Old with Diabetes

Based on the most recent guidelines, this patient who received PPSV23 in 2015 and 2020 should receive a single dose of PCV20 at least one year after their last PPSV23 dose (which would be after 12/18/2021). 1

Current Recommendations for Adults with Prior PPSV23 Vaccination

• The Advisory Committee on Immunization Practices (ACIP) now recommends that adults who have previously received PPSV23 should receive a single dose of PCV20 at least 1 year after their last PPSV23 dose. 1
• The 2023-2024 ACIP guidelines have updated pneumococcal vaccination recommendations to include newer conjugate vaccines (PCV15, PCV20, and PCV21) which provide broader serotype coverage than the older vaccines. 1
• Since this patient received their second PPSV23 dose on 12/18/2020, they would be eligible for PCV20 vaccination after 12/18/2021. 1

Special Considerations for Patients with Diabetes

• Diabetes is considered a chronic medical condition that increases the risk of pneumococcal disease, warranting comprehensive pneumococcal vaccination. 2
• People with diabetes are at higher risk for pneumococcal infections and more likely to develop complications from these infections. 2
• The ACIP specifically recommends pneumococcal vaccination for people with diabetes to reduce this risk. 2

Evolution of Pneumococcal Vaccination Recommendations

• Prior to 2019, the recommendation was for all adults ≥65 years to receive both PCV13 and PPSV23. 3
• In 2019, routine PCV13 was no longer recommended for all adults ≥65 years, with PPSV23 remaining the primary recommendation. 3
• The current recommendations (2023-2024) have shifted to favor the newer conjugate vaccines with broader coverage. 1
• The patient has already received the recommended two lifetime doses of PPSV23 (one before age 65 and one at/after age 65), but would benefit from the broader protection of newer conjugate vaccines. 1, 4

Benefits of Adding PCV20 After PPSV23

• PCV20 provides protection against additional serotypes not covered by the patient's previous PPSV23 vaccinations. 1
• Conjugate vaccines like PCV20 induce a T cell-dependent immune response that may provide more durable protection than polysaccharide vaccines (PPSV23). 5
• Studies show that initial vaccination with polysaccharide vaccines (like PPSV23) followed by conjugate vaccines still provides improved protection compared to polysaccharide vaccines alone. 6
• Research demonstrates that pneumococcal vaccination is effective in preventing pneumococcal diseases and reducing medical utilization in diabetic elderly patients. 7

Implementation Guidance

• The PCV20 vaccine should not be co-administered with PPSV23 on the same day. 1
• No additional PPSV23 doses are recommended after the dose administered at age ≥65 years, which this patient has already received. 1
• If PCV20 is administered, no additional pneumococcal vaccines would be needed in the future based on current guidelines. 1, 2

Potential Pitfalls to Avoid

• Avoid unnecessary revaccination with PPSV23 after the dose administered at age ≥65 years, as no additional doses are recommended and may lead to increased local reactions. 1, 4
• Be aware that the immune response to PCV vaccines may be somewhat diminished in patients who have previously received PPSV23, though still beneficial. 6, 5
• Don't delay vaccination - studies show that pneumococcal vaccination is effective in reducing invasive pneumococcal disease in diabetic elderly patients. 7