Pneumococcal Vaccine Options and Dosing Schedules
For adults, the CDC currently recommends a single dose of PCV20 (20-valent pneumococcal conjugate vaccine) as the preferred option for pneumococcal vaccination for all adults aged ≥65 years and adults 19-64 years with risk conditions who have not previously received a pneumococcal conjugate vaccine. 1
Current Recommendations Based on Age and Risk Factors
For Adults ≥65 Years:
- Primary recommendation: Single dose of PCV20 2, 1
- Alternative schedule (if PCV20 unavailable): Single dose of PCV15 followed by a dose of PPSV23 ≥1 year later 2
- For those who previously received PPSV23 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 2, 1
- For those who previously received PCV13 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PCV13 dose 2
- For those who received both PCV13 and PPSV23 but haven't received PPSV23 at age ≥65 years: Administer PCV20 after a ≥5 year interval since the last pneumococcal vaccine dose 2
For Adults 19-64 Years with Risk Conditions:
- Primary recommendation: Single dose of PCV20 2, 1
- Alternative schedule: Single dose of PCV15 followed by PPSV23 (timing varies based on specific risk factors) 2
Risk Conditions Warranting Vaccination at Ages 19-64:
- Chronic heart, liver, or lung disease 2
- Diabetes mellitus 2
- Cigarette smoking 2
- Alcoholism 2
- Cochlear implant or CSF leak 2
- Immunocompromising conditions (including HIV, malignancy, transplant recipients) 2
Special Populations and Considerations
Immunocompromised Adults:
- For adults with specified immunocompromising conditions who received PCV13 only: Administer PPSV23 after ≥8 weeks, then a second PPSV23 dose ≥5 years after the first PPSV23 dose 2
- For those with immunocompromising conditions who received PCV13 and one dose of PPSV23: Administer a second PPSV23 dose ≥5 years after the first PPSV23 dose 2
Hematopoietic Stem Cell Transplant Recipients:
- Recommended to receive 4 doses of PCV20, starting 3-6 months after HSCT 2, 1
- Administer 3 doses 4 weeks apart, then a fourth dose ≥6 months after the third dose or ≥12 months after HSCT (whichever is later) 2
- If PCV20 unavailable, give 3 doses of PCV15 4 weeks apart, followed by PPSV23 ≥1 year after HSCT 2
Important Clinical Considerations
- The shift to PCV20 as a single-dose option has simplified the pneumococcal vaccination schedule compared to previous recommendations 1
- Adults with immunocompromising conditions, CSF leak, or cochlear implant might benefit from shorter intervals (≥8 weeks) between PCV15 and PPSV23 2
- Not waiting the appropriate interval between different pneumococcal vaccines can reduce immune response 1
- Recent evidence supports expanding pneumococcal conjugate vaccination to all adults aged ≥50 years, not just those with risk factors 3
Common Pitfalls to Avoid
- Failing to identify adults aged 19-64 years with risk conditions who should receive pneumococcal vaccination 2
- Administering pneumococcal vaccines without respecting the recommended intervals between doses 1
- Not recognizing that vaccination schedules differ for immunocompromised patients compared to those with chronic medical conditions 2, 1
- Overlooking the need for pneumococcal vaccination in adults with asthma, which is now recognized as a risk factor 2
- Missing opportunities to vaccinate adults with diabetes, who have 1.4-5.9 times the risk for invasive pneumococcal disease compared to those without risk conditions 2
By following these updated recommendations, healthcare providers can help achieve the national objectives for pneumococcal vaccination coverage and reduce the burden of pneumococcal disease in adults.