What are the guidelines for pneumococcal (pneumonia) vaccination in a 70-year-old adult who has never received the vaccine?

From the Guidelines

For a 70-year-old adult who has never received a pneumonia vaccine, the current guidelines recommend a single dose of PCV21, PCV20, or PCV15, with PCV15 to be followed by a single dose of PPSV23 at least 1 year later. According to the most recent study 1, adults aged 65 years or older who have not previously received any pneumococcal vaccine should receive one of these conjugate vaccines. The options for vaccination include a single dose of PCV21, PCV20, or PCV15. If PCV15 is administered, a single dose of PPSV23 should be given at least 1 year after the PCV15 dose.

Key points to consider:

• The PCV vaccines (PCV21, PCV20, PCV15) provide protection against Streptococcus pneumoniae, which can cause serious infections including pneumonia, meningitis, and bloodstream infections 1.
• Adults 65 years or older are at increased risk of these infections, making vaccination crucial for this age group.
• The vaccines are generally well-tolerated, with minimal side effects, typically limited to soreness at the injection site, mild fever, or fatigue.
• Medicare Part B and most insurance plans cover pneumococcal vaccines for adults 65 and older, making them accessible to this population.

In terms of specific vaccine selection, PCV21, PCV20, or PCV15 can be used as the initial vaccine, with the choice depending on individual patient factors and vaccine availability. If PCV15 is used, a follow-up dose of PPSV23 is recommended at least 1 year later to provide additional protection against other strains of Streptococcus pneumoniae.

From the FDA Drug Label

Of the total number of Prevnar 20 recipients 18 years of age and older evaluated for safety in the 3 main clinical trials (N=4263), 26.7% (n=1138) were 65 years of age and older and 1.7% (n=72) were 80 years of age and older [see Clinical Studies (14. 2)]. Prevnar 20 recipients 70 through 79 years of age and ≥80 years of age had lower OPA GMTs for all pneumococcal serotypes compared to Prevnar 20 recipients 18 through 49 years, 50 through 59, and 60 through 64 years of age [see Clinical Studies (14. 1)].

The guidelines do not explicitly state the recommendations for a 70-year-old adult who has never received their pneumococcal vaccine. However, the label mentions that Prevnar 20 recipients 70 through 79 years of age had lower OPA GMTs for all pneumococcal serotypes compared to younger recipients, suggesting that vaccination may still be beneficial in this age group.

• Key points:
  • The label does not provide direct guidance on vaccination for a 70-year-old adult with no prior pneumococcal vaccination.
  • The vaccine has been evaluated for safety in individuals 18 years of age and older, including those 65 years of age and older.
  • Vaccination may still be beneficial in adults 70 years of age and older, despite lower OPA GMTs compared to younger recipients 2.

From the Research

Pneumococcal Vaccination Guidelines for Adults

• The guidelines for pneumococcal vaccination in adults, particularly those aged 70 years and older, are based on several studies that evaluated the effectiveness of different pneumococcal vaccines 3, 4, 5, 6.
• According to these studies, the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal conjugate vaccine (PCV13) are the two main vaccines available for adults at risk of pneumococcal disease.
• The effectiveness of these vaccines varies depending on the age group and underlying health conditions of the individual.

Vaccine Effectiveness in Older Adults

• A study published in 2022 found that sequential PCV13/PPSV23 vaccination was most effective for preventing pneumococcal community-acquired pneumonia (CAP) among adults aged 65-74 years, with an adjusted vaccine effectiveness of 80.3% 3.
• Another study published in 2020 found that the effectiveness of PPSV23 decreases over time and is best in younger age groups 4.
• A review of available evidence published in 2021 found that PPSV23 is effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia, but its effectiveness may be lower in adults aged 75 years and older, and those with certain underlying conditions 5.

Comparative Effectiveness of Pneumococcal Vaccines

• A retrospective cohort study published in 2022 found that PCV13 was associated with a decreased risk of pneumococcal pneumonia and "other" pneumonia compared to PPSV23, and that dual vaccination was also associated with a decrease in the rate of pneumococcal pneumonia and "other" pneumonia 6.
• The study found that PCV13 was associated with a 31% decrease in the rate of pneumococcal pneumonia in comparison to PPSV23 in older adult Veterans.

Recommendations for Adults Aged 70 Years and Older

• Based on the available evidence, it is recommended that adults aged 70 years and older receive pneumococcal vaccination, preferably with PCV13, to protect against pneumococcal disease 3, 4, 5, 6.
• The Centers for Disease Control and Prevention (CDC) recommends that adults aged 65 years and older receive a pneumococcal conjugate vaccine (PCV13 or Prevnar 13) followed by a pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23) at least 1 year later.