What is true about immunization except: pneumococcal (Pneumococcal Conjugate Vaccine (PCV) and Pneumococcal Polysaccharide Vaccine (PPSV)) vaccine administration for individuals over 65 years, every 5 years?

Pneumococcal Vaccination in Adults Over 65: The False Statement

Statement A is FALSE: pneumococcal vaccine is NOT given every 5 years to adults over 65 years of age. According to the most recent 2023 ACIP guidelines, adults ≥65 years receive pneumococcal vaccination as a one-time series, not on a recurring 5-year schedule 1.

Current Pneumococcal Vaccination Recommendations for Adults ≥65 Years

Standard Approach (No Immunocompromising Conditions)

• Adults ≥65 years with no prior pneumococcal vaccination should receive a single dose of PCV20 1, 2
• If previously received PPSV23 only, give one dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2
• If previously received PCV13 only, give one dose of PCV20 at least 1 year after the PCV13 dose 1, 2
• After PCV20 administration, no additional pneumococcal vaccines are needed 2

The 5-Year Interval Misconception

The confusion about "every 5 years" stems from older recommendations that are no longer current:

• The 5-year interval only applies in specific scenarios where adults received both PCV13 and PPSV23 previously and are considering an additional PCV20 dose 1
• This is NOT a routine revaccination schedule but rather a one-time consideration for those who completed the old two-vaccine series 1
• Shared clinical decision-making is recommended for this scenario, and if PCV20 is given, it should be ≥5 years after the last pneumococcal vaccine dose 1

Special Populations: Immunocompromised Adults

For adults with immunocompromising conditions, CSF leak, or cochlear implant:

• Give PCV15 followed by PPSV23 at ≥8 weeks (not 1 year) if using the two-vaccine approach 1
• Alternatively, give a single dose of PCV20 1
• Even in immunocompromised patients, this is NOT repeated every 5 years 1

Verification of Other Statements

Statement B: Hepatitis B - 3 Initial Doses

TRUE - The standard hepatitis B vaccination series consists of 3 doses given at 0,1, and 6 months (general medical knowledge).

Statement C: Varicella - 2 Doses at 0 and 4-8 Weeks

TRUE - Varicella vaccine for adults without evidence of immunity requires 2 doses separated by 4-8 weeks (general medical knowledge).

Statement D: Influenza Annually for Susceptible Individuals

TRUE - Annual influenza vaccination is recommended for all adults, particularly those at high risk (general medical knowledge).

Key Clinical Pitfalls to Avoid

• Do not revaccinate adults ≥65 years with pneumococcal vaccine every 5 years - this is outdated practice 1
• Once PCV20 is administered, the pneumococcal vaccination series is complete for most patients 2
• The only scenario requiring consideration of additional vaccination is when both PCV13 and PPSV23 were previously given at age ≥65, and even then it requires shared decision-making, not automatic administration 1
• Ensure at least 1 year has passed since the last PPSV23 dose before administering PCV20 in immunocompetent adults 1, 2