What is the CDC's recommended pneumococcal (Pneumococcus) vaccine schedule for a 65-year-old?

CDC Pneumococcal Vaccine Recommendations for 65-Year-Olds

For adults aged ≥65 years, the CDC recommends a single dose of PCV20 as the preferred option for pneumococcal vaccination if they have not previously received a pneumococcal conjugate vaccine. 1, 2

Current Recommendations

• The Advisory Committee on Immunization Practices (ACIP) has updated its pneumococcal vaccination recommendations to include newer conjugate vaccines (PCV15, PCV20, PCV21) which provide broader serotype coverage 1
• For adults aged ≥65 years who have never received a pneumococcal vaccine, there are two options:
  • A single dose of PCV20 (preferred for simplicity) 1, 2
  • A single dose of PCV15 followed by a dose of PPSV23 at least 1 year later 1
• Prior to 2019, the recommendation was for all adults ≥65 years to receive both PCV13 and PPSV23 1

Recommendations Based on Prior Vaccination History

• If previously received PPSV23 before age 65: Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2
• If previously received PCV13: Administer a single dose of PCV20 or PPSV23 at least 1 year after the PCV13 dose 1
• If previously received PPSV23 at age ≥65 years: No additional doses of PPSV23 should be administered 3, 4

Special Considerations for High-Risk Conditions

• For adults with immunocompromising conditions, CSF leaks, or cochlear implants, the vaccination schedule is more aggressive with shorter intervals between doses 1, 4
• These conditions include: 3, 4
  • Congenital or acquired asplenia
  • Sickle cell disease/other hemoglobinopathies
  • Chronic renal failure
  • Congenital or acquired immunodeficiencies
  • HIV infection
  • Malignancies and immunosuppressive treatments

Important Clinical Considerations

• PCV13 is no longer routinely recommended for all adults aged ≥65 years since 2019, as it has been replaced by newer pneumococcal conjugate vaccines with broader coverage 1, 4
• Pneumococcal vaccines should not be co-administered with each other 1, 2
• Not waiting the appropriate interval between different pneumococcal vaccines can reduce immune response 2, 5
• Studies have shown that receiving PPSV23 before PCV13 can diminish the response to subsequent administration of PCV13 6, 5

Common Pitfalls to Avoid

• Failing to identify adults with risk conditions who should receive pneumococcal vaccination 2
• Administering pneumococcal vaccines without respecting the recommended intervals between doses 2
• Not recognizing that vaccination schedules differ for immunocompromised patients compared to those with chronic medical conditions 4, 2
• Missing opportunities to vaccinate adults with chronic conditions such as diabetes, heart disease, lung disease, or liver disease 4, 2

The updated recommendations reflect the evolution of pneumococcal vaccines and the changing epidemiology of pneumococcal disease, with the goal of providing optimal protection against pneumococcal disease while simplifying the vaccination schedule 1, 2.