For which individuals is pneumococcal (Streptococcus pneumoniae) vaccination recommended?

Pneumococcal Vaccination Indications

All adults aged ≥65 years should receive pneumococcal vaccination, along with younger adults (aged 19-64 years) who have chronic medical conditions, immunocompromising conditions, functional or anatomic asplenia, or specific risk factors including cigarette smoking. 1

Universal Age-Based Recommendations

Adults ≥65 years: All individuals in this age group require pneumococcal vaccination regardless of health status or prior vaccination history. 1, 2 The vaccine options are either:

• One dose of PCV20 alone, OR
• One dose of PCV15 followed by PPSV23 at least 1 year later 1

If vaccination status is unknown in adults ≥65 years, administer one dose of vaccine. 2

Risk-Based Recommendations for Adults Aged 19-64 Years

Chronic Medical Conditions

Adults aged 19-64 years with the following conditions require pneumococcal vaccination 1, 2:

Cardiovascular conditions:

• Chronic heart disease (including congestive heart failure, cardiomyopathies, and valve diseases) - these patients have up to 3.3 times the odds for community-acquired pneumonia and 9.9 times the odds for invasive pneumococcal disease 1

Pulmonary conditions:

• Chronic lung disease (COPD, emphysema) - note that asthma alone is NOT an indication 1, 2

Metabolic and endocrine:

• Diabetes mellitus 1, 2

Hepatic and renal:

• Chronic liver disease (cirrhosis) 1, 2
• Chronic renal failure 1, 2
• Nephrotic syndrome 1, 2

Behavioral and substance use:

• Alcoholism 1, 2
• Cigarette smoking - smokers have 2.8-4.1 times the risk for invasive pneumococcal disease compared to adults without risk factors 1

Anatomic conditions:

• Cerebrospinal fluid (CSF) leaks 1, 2
• Cochlear implants 1, 2

Immunocompromising Conditions

These patients require vaccination despite potentially reduced vaccine effectiveness, as the benefits justify use 1, 2:

• HIV infection (vaccinate as soon as possible after diagnosis confirmation) 1, 2
• Functional or anatomic asplenia (including sickle cell disease) 1, 2
• Congenital or acquired immunodeficiencies 1, 2
• Leukemia, lymphoma, Hodgkin disease 1, 2
• Multiple myeloma, generalized malignancy 1, 2
• Organ or bone marrow transplantation 1, 2
• Immunosuppressive chemotherapy or long-term systemic corticosteroids 1, 2

Special Populations and Settings

Institutional residents: Assess vaccination status for all residents of nursing homes and long-term care facilities on admission and vaccinate as needed. 1, 2

High-risk populations: Alaskan Natives and certain American Indian populations living in environments where risk for invasive pneumococcal disease is increased. 1, 2

Critical Timing Considerations

Before immunosuppression: Administer pneumococcal vaccine at least 2 weeks before:

• Elective splenectomy 1, 2
• Initiation of cancer chemotherapy or immunosuppressive therapy 1, 2

Avoid vaccination during: Active chemotherapy or radiation therapy. 1

After transplant: For hematopoietic stem cell transplant recipients, begin vaccination 3-6 months after transplant. 2

Important Clinical Considerations

Concurrent administration: Pneumococcal vaccine can be given simultaneously with influenza vaccine (separate injection in opposite arm) without increased side effects or decreased antibody response. 1, 2

Asplenic patients warning: These patients must understand that vaccination does not guarantee protection against fulminant pneumococcal disease, which carries a 50-80% case-fatality rate. They require prompt medical attention for unexplained fever or sepsis manifestations. 1, 2

Diabetes-specific emphasis: Pneumococcal vaccination significantly reduces morbidity and mortality in diabetic patients, particularly those with cardiac or renal disease or recent hospitalization. 1

Common Pitfalls to Avoid

• Missing opportunities in middle-aged adults: Adults aged 50-64 years commonly have chronic illness (12% have pulmonary risk factors), so assess vaccination status at age 50 and during routine visits. 1, 2
• Asthma misconception: Asthma alone is NOT an indication for pneumococcal vaccination. 1, 2
• Delaying HIV vaccination: Vaccinate HIV-positive patients immediately after diagnosis confirmation, not later. 2
• Forgetting adolescent assessment: Check vaccination status during the adolescent immunization visit at 11-12 years of age for those with risk factors. 1, 2
• Withholding vaccine for uncertain history: If vaccination status is unknown, administer the vaccine rather than withholding it. 1