Which pneumonia vaccine to administer?

Pneumococcal Vaccine Administration Guidelines

For adults who need pneumococcal vaccination, the 21-valent pneumococcal conjugate vaccine (PCV21) is the preferred option, followed by PCV20 as an alternative, due to their broader serotype coverage and simplified vaccination schedules. 1, 2

General Recommendations by Age and Risk Group

Adults ≥65 Years

• For those who have never received any pneumococcal vaccine, administer a single dose of PCV21 or PCV20 (preferred options) 1, 3
• Alternatively, administer PCV15 followed by PPSV23 at least 1 year later 1
• If previously received PPSV23, administer PCV21 or PCV20 at least 1 year after the PPSV23 dose 1, 3
• If previously received PCV13, administer PCV21, PCV20, or PPSV23 at least 1 year after the PCV13 dose 1

Adults 19-64 Years with Immunocompromising Conditions, CSF Leak, or Cochlear Implant

• For those who have never received any pneumococcal vaccine, administer a single dose of PCV21 or PCV20 (preferred options) 1
• Alternatively, administer PCV15 followed by PPSV23 at least 8 weeks later 1
• If previously received PPSV23, administer PCV21 or PCV20 at least 1 year after the PPSV23 dose 1
• If previously received PCV13, administer PCV21, PCV20, or PPSV23; if PPSV23 is used, administer at least 8 weeks after PCV13 1

Adults 19-64 Years with Chronic Medical Conditions

• For those who have never received any pneumococcal vaccine, administer a single dose of PCV21 or PCV20 (preferred options) 1, 2
• Alternatively, administer PCV15 followed by PPSV23 at least 1 year later 1, 3
• If previously received PPSV23, administer PCV21 or PCV20 at least 1 year after the PPSV23 dose 1

Specific Vaccination Sequences

Optimal Order of Administration

• When both conjugate (PCV) and polysaccharide (PPSV23) vaccines are indicated, administer the conjugate vaccine first 2, 4
• This sequence produces a better immune response than when PPSV23 is given first 5, 4

Interval Between Vaccines

• For non-immunocompromised adults: PCV followed by PPSV23 with ≥1 year interval 2, 3
• For immunocompromised adults: PCV followed by PPSV23 with ≥8 weeks interval 1, 2
• If PPSV23 was given first, wait ≥1 year before administering any PCV 1, 2

Special Considerations

Prior Vaccination Scenarios

• For adults who previously received both PCV13 and PPSV23 (with PPSV23 at age ≥65 years), shared clinical decision-making is recommended regarding administration of PCV21 or PCV20 1, 3
• If decision is made to administer PCV21 or PCV20, wait ≥5 years after the last pneumococcal vaccine dose 1
• If PCV21 or PCV20 is used in place of any dose of PPSV23, the series is considered complete 1, 2

Evolution of Recommendations

• Prior to 2019, the recommendation was for all adults ≥65 years to receive both PCV13 and PPSV23 1, 3
• In 2019, routine PCV13 was no longer recommended for all adults ≥65 years, with PPSV23 remaining the primary recommendation 1, 3
• The 2023-2024 ACIP guidelines have updated recommendations to include newer conjugate vaccines (PCV15, PCV20, PCV21) which provide broader serotype coverage 1, 3

Common Pitfalls to Avoid

• Overlooking risk factors: Immunocompromised patients need shorter intervals (≥8 weeks vs ≥1 year) between PCV and PPSV23 1, 2
• Unnecessary revaccination: If PCV21 or PCV20 is used, additional pneumococcal vaccination is generally not needed 1, 2
• Incorrect timing: Pneumococcal vaccines should not be co-administered with each other on the same day 3, 4
• Failing to recognize that newer conjugate vaccines (PCV15, PCV20, PCV21) have simplified pneumococcal vaccination schedules by reducing the need for sequential vaccination in many cases 2, 3