Recommended Interval Between Prevenar 13 and Pneumovax 23
The interval between Prevenar 13 (PCV13) and Pneumovax 23 (PPSV23) depends on the patient's risk status: for adults with immunocompromising conditions, CSF leak, or cochlear implant, PPSV23 should be given ≥8 weeks after PCV13; for all other adults (including those ≥65 years without these conditions), PPSV23 should be given ≥1 year after PCV13. 1
Risk-Based Interval Recommendations
High-Risk Adults (8-Week Interval)
The shorter 8-week interval applies specifically to adults with:
- Immunocompromising conditions (HIV infection, congenital or acquired immunodeficiencies, iatrogenic immunosuppression, generalized malignancy, chronic renal failure, nephrotic syndrome, asplenia) 1
- Cerebrospinal fluid (CSF) leak 1
- Cochlear implant 1
For these high-risk populations, the minimum interval between PCV13 and PPSV23 is ≥8 weeks, allowing for earlier protection against the additional serotypes covered by PPSV23 1.
Standard-Risk Adults (1-Year Interval)
For adults without the above high-risk conditions, including:
- All adults aged ≥65 years without immunocompromising conditions, CSF leak, or cochlear implant 1
- Adults aged 19-64 years with chronic medical conditions only (chronic heart disease, chronic lung disease, chronic liver disease, diabetes, alcoholism, smoking) 1
The minimum interval between PCV13 and PPSV23 is ≥1 year 1, 2.
Important Context: Current Guideline Evolution
Critical caveat: The 2023-2024 ACIP guidelines now recommend newer pneumococcal conjugate vaccines (PCV20, PCV21, or PCV15) as preferred options over the sequential PCV13-PPSV23 regimen 1. The PCV13-PPSV23 sequential approach is primarily relevant for patients who have already received PCV13 and need to complete their vaccination series 1.
For Patients Who Already Received PCV13 Only:
- Preferred option: Give a single dose of PCV20 ≥1 year after PCV13 (this completes the series; no PPSV23 needed) 1, 2
- Alternative option: Give PPSV23 using the intervals described above (≥8 weeks for high-risk, ≥1 year for standard-risk) 1
Evidence Supporting the Interval Recommendations
The FDA label for Pneumovax 23 documents a clinical trial evaluating sequential administration of Prevnar 13 followed by PNEUMOVAX 23, comparing an 8-week interval versus a 26-week interval 3. Both intervals were well-tolerated and immunogenic 3, 4. However, ACIP guidelines establish the minimum intervals based on risk stratification to optimize immune response while ensuring safety 1.
Research demonstrates that administration of PPSV23 at either 8 weeks or 26 weeks following PCV13 does not negatively impact immune responses and can provide earlier protection against serotypes unique to PPSV23 4. The 8-week interval for high-risk patients balances the need for rapid protection with adequate immune priming from the conjugate vaccine 1.
Common Pitfalls to Avoid
- Do not use the 8-week interval for standard-risk adults: The 1-year interval is required for adults without immunocompromising conditions, CSF leak, or cochlear implant 1
- Consider PCV20 instead of PPSV23: For patients who received PCV13 only, giving PCV20 (≥1 year after PCV13) simplifies the vaccination schedule and eliminates the need for PPSV23 1, 2
- Do not give additional doses after completing the series: Once a patient receives PPSV23 at age ≥65 years (following PCV13), no additional pneumococcal vaccines are routinely needed, though shared clinical decision-making may be considered for PCV20 ≥5 years later 1