From the Guidelines
Adults aged 19-64 years with immunocompromising conditions should receive a single dose of PCV20, or if PCV20 is not available, a single dose of PCV15 followed by a single dose of PPSV23 at least 8 weeks later, according to the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) in 2023 1. The pneumococcal vaccine schedule for adults with immunocompromising conditions has been updated to reflect the availability of new vaccines, including PCV20. Key points to consider when vaccinating adults with immunocompromising conditions include:
- The type of vaccine previously received, such as PCV7, PCV13, PPSV23, or none
- The interval since the last dose of vaccine, with recommendations for intervals of at least 1 year or 5 years between doses
- The availability of PCV20, which can be used as a single dose, or PCV15 and PPSV23, which should be used in a series with an interval of at least 8 weeks between doses The guidelines also emphasize the importance of reviewing pneumococcal vaccine recommendations again when the patient turns 65 years old, as the vaccine schedule may change at that time 1. Some of the immunocompromising conditions that require special consideration when vaccinating against pneumococcal disease include:
- Chronic renal failure
- Congenital or acquired asplenia
- Congenital or acquired immunodeficiency
- Generalized malignancy
- HIV infection
- Iatrogenic immunosuppression
- Leukemia
- Lymphoma
- Multiple myeloma
- Nephrotic syndrome
- Sickle cell disease and other hemoglobinopathies
- Solid organ transplant These conditions increase the risk of serious pneumococcal disease, making vaccination an important preventive measure 1.
From the Research
Guidelines for Pneumonia Vaccine
- The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of pneumococcal conjugate vaccine (PCV) for all PCV-naïve adults aged ≥50 years 2.
- Options for PCV include 20-valent PCV (PCV20), 21-valent PCV (PCV21), or 15-valent PCV (PCV15) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2.
- For adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13), there are additional recommendations for use of PCV20 or PCV21 2.
- The 13-valent pneumococcal conjugate vaccine (PCV13) is immunogenic and safe in children 6-17 years of age with sickle cell disease previously vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23) 3.
- PCV13 combined with PPSV23 may be superior to PPSV23 alone for reducing incidence or severity of pneumonia in older adults 4.
- The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is effective against vaccine-type invasive pneumococcal disease and vaccine-type pneumococcal pneumonia, and can lower the burden of vaccine-type pneumococcal pneumonia 5.
- A systematic review and meta-analysis found that PPSV23 is effective against invasive pneumococcal disease and pneumococcal pneumonia in adults aged ≥60 years, with a pooled vaccine efficacy of 73% against invasive pneumococcal disease and 64% against pneumococcal pneumonia 6.
Special Considerations
- Children with sickle cell disease who were previously vaccinated with PPSV23 responded well to 1 PCV13 dose, and a second dose did not increase antibody response 3.
- PCV13 antibodies persisted above pre-vaccination levels for all serotypes 1 year after dose 2 in children with sickle cell disease 3.
- PPSV23-conferred protection may be lower in adults aged ≥75 years, those with certain underlying conditions, and individuals who were vaccinated >5 years before disease onset 5.