From the Guidelines
All adults aged 65 years and older, as well as younger individuals with certain medical conditions, should receive pneumococcal vaccination, typically with both PCV21, PCV20, or PCV15 and PPSV23 vaccines in a sequential schedule, as recommended by the most recent guidelines 1. The indications for pneumococcal vaccination have been updated to include specific populations at increased risk of pneumococcal disease.
- Adults aged 65 years and older should receive a single dose of PCV21, PCV20, or PCV15, and if PCV15 is administered, a single dose of PPSV23 should be administered ≥1 year after the PCV15 dose.
- Younger individuals with immunocompromising conditions, such as HIV infection, cancer, or immunosuppressive therapy, should receive a single dose of PCV21, PCV20, or PCV15, and if PCV15 is used, administer a single dose of PPSV23 ≥8 weeks after the PCV15 dose.
- Those with chronic medical conditions, such as chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking, cochlear implants, cerebrospinal fluid leaks, asplenia (functional or anatomic), and sickle cell disease, should also receive pneumococcal vaccination. The vaccines work by stimulating the immune system to produce antibodies against pneumococcal capsular polysaccharides, providing protection against invasive pneumococcal diseases including pneumonia, meningitis, and bacteremia. Key considerations for vaccination include:
- Age: Adults aged 65 years and older, as well as younger individuals with certain medical conditions.
- Risk factors: Immunocompromising conditions, chronic medical conditions, and other underlying health conditions.
- Previous vaccination history: Consultation with a healthcare provider is essential for determining the appropriate vaccination schedule. The most recent guidelines from the Advisory Committee on Immunization Practices 1 provide recommendations for the use of PCV21, PCV20, and PCV15 in adults aged 19 years and older.
- A single dose of PCV21, PCV20, or PCV15 is recommended for adults with immunocompromising conditions, such as HIV infection, cancer, or immunosuppressive therapy.
- A single dose of PCV21, PCV20, or PCV15 is also recommended for adults with chronic medical conditions, such as chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking, cochlear implants, cerebrospinal fluid leaks, asplenia (functional or anatomic), and sickle cell disease. It is essential to consult with a healthcare provider to determine the appropriate vaccination schedule based on individual risk factors and previous vaccination history.
From the Research
Indications for Pneumococcal Vaccination
The indications for pneumococcal vaccination are as follows:
- Adults aged 65 years and older are recommended to receive a pneumococcal conjugate vaccine (PCV) 2
- Adults aged 50-64 years are also recommended to receive a PCV 2
- Adults with risk conditions for pneumococcal disease, such as chronic medical conditions, are recommended to receive a PCV 2
- The use of PCV13 in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) has been shown to be effective in preventing vaccine-type community-acquired pneumonia 3
Vaccine Recommendations
The recommended vaccines for pneumococcal disease are:
- 20-valent PCV (PCV20) alone or 21-valent PCV (PCV21) alone 2
- 15-valent PCV (PCV15) in series with PPSV23 2
- PCV13 in series with PPSV23 3, 4
Effectiveness of Pneumococcal Vaccination
The effectiveness of pneumococcal vaccination has been studied in several studies:
- A systematic review of studies published between 2016 and 2019 found that PCV13 and PPSV23 were effective in preventing invasive pneumococcal disease and pneumonia among an unselected elderly population 5
- A study published in 2023 found that the sequential administration of PCV13 followed by PPSV23 provided better booster effects than a single dose of PPSV23 in pneumococcal vaccine-naïve adults aged 65 years and older 4
- A study published in 2010 found that pneumococcal polysaccharide vaccination coverage among adults aged 65 years and older in the US increased from 14.1% in 1989 to 60.1% in 2008 6