What is the recommended schedule for receiving the pneumonia vaccination, including Prevnar 13 (pneumococcal conjugate vaccine) and Pneumovax 23 (pneumococcal polysaccharide vaccine)?

Pneumococcal Vaccination Schedule

For adults ≥65 years who have never received pneumococcal vaccination, give a single dose of PCV20 (preferred) and you're done—no additional doses are needed. 1, 2, 3

Adults ≥65 Years: Primary Recommendations

Never Previously Vaccinated

• Single dose of PCV20 is the preferred option for simplicity and completion of the series 1, 2, 3
• Alternative: PCV15 followed by PPSV23 at least 1 year later 1
• No additional doses are needed after completing either regimen 1

Previously Received PPSV23 Only

• Give single dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2, 3
• This completes the vaccination series—no further doses needed 1

Previously Received PCV13 Only

• Give single dose of PCV20 or PPSV23 at least 1 year after PCV13 1
• For immunocompromised patients who received PCV13 only: add PPSV23 ≥8 weeks after PCV13, then a second PPSV23 ≥5 years later 3

Previously Received Both PCV13 and PPSV23 at Age ≥65

• No additional doses are routinely recommended 2
• Shared clinical decision-making may consider PCV20 ≥5 years after the last dose 1

Adults 19-64 Years with Risk Conditions

Risk Conditions Warranting Vaccination

• Chronic heart, liver, or lung disease 3
• Diabetes mellitus 3
• Cigarette smoking or alcoholism 3
• Cochlear implant or CSF leak 3
• Immunocompromising conditions (chronic renal failure, asplenia, HIV, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, complement deficiencies) 1, 3

Vaccination Schedule

• Single dose of PCV20 (preferred) for those never vaccinated 3
• Alternative: PCV15 followed by PPSV23 1
• Review vaccination status again when turning 65 to determine if additional doses are needed based on prior history 1

Special Populations: Immunocompromised Adults

Timing Intervals Differ Based on Immune Status

• Immunocompromised patients require shorter intervals: ≥8 weeks between PCV and PPSV23 (versus ≥1 year for immunocompetent adults) 1, 3
• This shorter interval reflects greater urgency for protection in higher-risk patients 1

PPSV23 Boosters for Immunocompromised

• Second PPSV23 dose given ≥5 years after the first PPSV23 for adults 19-64 years with immunocompromising conditions 1
• This applies to conditions like chronic renal failure, asplenia, HIV infection, malignancies with immunosuppressive therapy, sickle cell disease, and transplant recipients 1

Hematopoietic Stem Cell Transplant Recipients

• 4 doses of PCV20 starting 3-6 months after HSCT 3

Children: PCV13 Vaccination Schedule

Infants 2-6 Months (Standard Series)

• 4-dose series at ages 2,4,6, and 12-15 months 4
• Primary series: 3 doses with intervals of approximately 8 weeks (minimum 4 weeks) 4
• Fourth (booster) dose at 12-15 months, at least 8 weeks after third dose 4

Infants 7-11 Months (Catch-Up)

• 3 doses total: first 2 doses at least 4 weeks apart, third dose at 12-15 months (at least 8 weeks after second dose) 4

Children 12-23 Months (Catch-Up)

• 2 doses with interval of at least 8 weeks 4

Children 24-59 Months (Catch-Up)

• Healthy children: single dose of PCV13 4
• Children with underlying medical conditions (24-71 months): 2 doses of PCV13 with interval of at least 8 weeks 4

Children with Underlying Medical Conditions Requiring PPSV23

• PPSV23 given at least 8 weeks after most recent PCV13 dose for children aged 2-18 years with high-risk conditions 1

Critical Timing Rules

Minimum Intervals Between Vaccines

• PCV and PPSV23 should NEVER be given on the same day 2, 3
• Immunocompetent adults: ≥1 year between PCV and PPSV23 1
• Immunocompromised adults: ≥8 weeks between PCV and PPSV23 1, 3
• Children <1 year: minimum 4 weeks between PCV doses 4
• Children ≥1 year: minimum 8 weeks between PCV doses 4

Pre-Procedure Timing

• Complete vaccination at least 2 weeks before elective splenectomy or initiation of immunosuppressive therapy 1

Common Pitfalls to Avoid

• Do not give multiple PPSV23 doses to adults ≥65 years who received PPSV23 at age ≥65—only one dose is needed at this age 1
• Do not use 5-year PPSV23 boosters for immunocompetent adults—this only applies to select immunocompromised patients who received their first dose before age 65 1
• Do not fail to identify adults 19-64 with risk conditions (diabetes, chronic lung disease, smoking) who need vaccination 3
• Do not administer different pneumococcal vaccines without respecting recommended intervals—this reduces immune response 3
• Do not overlook that vaccination schedules differ for immunocompromised versus immunocompetent patients (8 weeks vs 1 year intervals) 1, 3