What is the recommended schedule for Pneumococcal Polysaccharide (PPSV23) vaccination?

PPSV23 Vaccination Schedule for Adults

For adults requiring pneumococcal vaccination, the current recommendation is to administer a single dose of PCV20 as the preferred option, which eliminates the need for PPSV23 in most cases. 1, 2

General PPSV23 Recommendations (When PCV20 is Not Available)

• For adults aged ≥65 years without previous pneumococcal vaccination, administer PCV15 followed by PPSV23 after ≥1 year 1
• For adults aged ≥65 years with immunocompromising conditions, CSF leak, or cochlear implant, administer PCV15 followed by PPSV23 after ≥8 weeks 1
• For adults aged 19-64 years with chronic medical conditions (alcoholism, heart disease, liver disease, lung disease, smoking, diabetes), administer PCV15 followed by PPSV23 after ≥1 year 1
• For adults aged 19-64 years with immunocompromising conditions, CSF leak, or cochlear implant, administer PCV15 followed by PPSV23 after ≥8 weeks 1, 3

For Patients with Prior Pneumococcal Vaccination

If previously received PPSV23 only:

• Administer PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1
• No additional PPSV23 dose is needed after PCV20 or PCV15 1

If previously received PCV13 only:

• For non-immunocompromised adults: Administer PPSV23 ≥1 year after PCV13 1
• For immunocompromised adults: Administer PPSV23 ≥8 weeks after PCV13 1

If previously received both PCV13 and PPSV23:

• If PPSV23 was not yet given at age ≥65 years: Administer PPSV23 after ≥1 year since PCV13 and ≥5 years since last PPSV23 1
• If PPSV23 was already given at age ≥65 years: No additional pneumococcal vaccination is generally needed 1

Special Population: HSCT Recipients

• For hematopoietic stem cell transplant recipients, administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth PCV20 dose ≥6 months after the third dose or ≥12 months after HSCT, whichever is later 1
• If PCV20 is not available, administer 3 doses of PCV15 4 weeks apart, followed by a single dose of PPSV23 ≥1 year after HSCT 1

Important Clinical Considerations

• Always check the patient's prior pneumococcal vaccination history before administering any pneumococcal vaccine 2, 3
• Maintain proper intervals between different pneumococcal vaccines to ensure optimal immune response 2, 3
• For immunocompromised patients, shorter intervals (≥8 weeks vs ≥1 year) between PCV and PPSV23 are recommended to provide more rapid protection 1, 3
• PPSV23 provides the broadest serotype coverage among available pneumococcal vaccines, but PCVs have immunologic advantages 1
• The effectiveness of pneumococcal vaccination may vary by age group, with sequential PCV13/PPSV23 vaccination showing the highest effectiveness (80.3%) in adults aged 65-74 years 4

Common Pitfalls to Avoid

• Administering PPSV23 and PCV15/PCV20 during the same visit (they should not be given simultaneously) 1
• Failing to recognize that immunocompromised patients need shorter intervals between vaccines 1, 3
• Unnecessarily revaccinating patients who have already received PCV20, as it generally eliminates the need for additional pneumococcal vaccination 2, 3
• Not waiting the recommended interval after a previous PPSV23 dose before administering PCV15 or PCV20 (should be ≥1 year) 1