From the Guidelines
The recommendation for pneumonia vaccine boosters changed in 2022 when the CDC's Advisory Committee on Immunization Practices (ACIP) updated their guidelines for pneumococcal vaccination in adults, as stated in the 2023 guidelines 1, 2, 3, 4, 5, 6. The new recommendations eliminated the need for age-based boosters of the PPSV23 (Pneumovax) vaccine that were previously recommended for adults 65 and older who had received their first dose before age 65. Instead, the current recommendation is for adults 65 and older to receive either a single dose of PCV20 (Prevnar 20) or a dose of PCV15 (Vaxneuvance) followed by PPSV23 at least one year later. This change was based on evidence showing that the newer conjugate vaccines (PCV15 and PCV20) provide broader and more durable protection against pneumococcal disease. The updated recommendations simplify the vaccination schedule while maintaining effective protection against pneumococcal infections, which are a significant cause of pneumonia, meningitis, and bloodstream infections in older adults.
Some key points to consider:
- Adults aged ≥19 years with an immunocompromising condition, a CSF leak, or a cochlear implant who have received both PCV13 and PPSV23 with incomplete vaccination status are recommended to complete their pneumococcal vaccine series by receiving either a single dose of PCV20 at an interval at least 5 years after the last pneumococcal vaccine dose or ≥1 dose of PPSV23 6.
- Shared clinical decision-making is recommended regarding PCV20 use for adults aged ≥65 years who have completed the recommended vaccine series with both PCV13 (at any age) and PPSV23 (which was administered at age ≥65 years) 6.
- Adults aged ≥19 years who have received PCV13 only are recommended to receive a single dose of PCV20 at an interval ≥1 year after receipt of the PCV13 dose or to receive ≥1 dose of PPSV23 to complete their pneumococcal vaccine series 6.
Overall, the updated recommendations aim to provide effective protection against pneumococcal disease while simplifying the vaccination schedule for adults.
From the Research
Pneumonia Vaccine Booster Age Change
- The recommendation for pneumonia vaccine booster age has changed over time, with updates to the guidelines for adults aged 50 years and older 7.
- Previously, the Advisory Committee on Immunization Practices (ACIP) recommended pneumococcal conjugate vaccine (PCV) for adults aged 65 years and older, as well as those with risk conditions for pneumococcal disease 8, 9.
- As of October 2024, ACIP recommends a single dose of PCV for all PCV-naïve adults aged 50 years and older 7.
- The change in recommendation is based on evidence from studies evaluating the effectiveness of pneumococcal vaccines in preventing pneumococcal pneumonia in older adults 10, 9.
- The updated guidelines aim to provide better protection against pneumococcal disease in adults aged 50 years and older, and to reduce the burden of pneumococcal pneumonia in this population 7.
Key Studies
- A 2014 study published in the Annals of the American Thoracic Society discussed the Centers for Disease Control and Prevention recommendations for pneumococcal vaccines, including the use of PCV and 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults 8.
- A 2022 study published in The Journal of Infectious Diseases evaluated the effectiveness of PCV13, PPSV23, and sequential vaccination against pneumococcal pneumonia in older adults, finding that sequential PCV13/PPSV23 vaccination was most effective in preventing pneumococcal community-acquired pneumonia among adults aged 65-74 years 10.
- A 2015 study published in The New England Journal of Medicine found that PCV13 was effective in preventing vaccine-type pneumococcal community-acquired pneumonia and invasive pneumococcal disease in adults aged 65 years and older 9.