What are the recommended vaccine schedules for pneumonia and shingles in adults aged 60 and above?

Pneumonia and Shingles Vaccination for Adults Aged 60 and Above

Shingles Vaccination

Adults aged 60 and above should receive the recombinant zoster vaccine (Shingrix/RZV) as a two-dose series, with the second dose administered 2-6 months after the first dose, regardless of prior shingles history or previous Zostavax vaccination. 1

Key Recommendations for Shingles Vaccine

• Start vaccination at age 60 or above with a single dose of zoster vaccine, though the vaccine is FDA-approved starting at age 50 2
• The two-dose Shingrix series demonstrates 97.2% efficacy in preventing herpes zoster in adults aged 50 years and older, with protection persisting for at least 8 years 1
• Administer the vaccine regardless of whether the patient reports a prior episode of herpes zoster 2
• Patients with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication such as pregnancy or severe immunodeficiency 2

Dosing Schedule Details

• The minimum interval between doses is 4 weeks, though 2-6 months is recommended 1
• If the second dose is administered beyond 6 months, effectiveness is not impaired, with real-world data showing doses given at ≥180 days maintain full effectiveness 3
• Real-world vaccine effectiveness is 70.1% for the two-dose series and 56.9% for a single dose, emphasizing the importance of completing both doses 3

Revaccination After Zostavax

• Adults who previously received Zostavax (live attenuated vaccine) should receive the full 2-dose Shingrix series at least 2 months after the last Zostavax dose 1
• This recommendation is critical because Zostavax efficacy declines dramatically to only 14.1% by year 10, whereas Shingrix maintains superior long-term protection 1, 4

Common Side Effects

• Injection-site reactions (pain, redness, swelling) occur in 9.5% of recipients (grade 3 reactions) compared to 0.4% with placebo 1
• Systemic symptoms occur in 11.4% of vaccine recipients versus 2.4% in placebo recipients 1
• Despite these side effects, no serious safety concerns have been identified in large clinical trials 1

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Pneumococcal Vaccination

Adults aged 65 years and older with no previous pneumococcal vaccination should receive a single dose of PCV20 (20-valent pneumococcal conjugate vaccine). 5

Key Recommendations for Pneumococcal Vaccine

• For adults aged ≥65 years who have never been vaccinated, administer a single dose of PCV20 2, 5
• For adults aged ≥65 years who previously received PPSV23 only, administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 2, 5
• For adults aged ≥65 years who previously received PCV13 only, administer either a single dose of PCV20 at least 1 year after PCV13, or administer PPSV23 at least 1 year after PCV13 (or ≥8 weeks for those with immunocompromising conditions) 2

Alternative Schedule Option

• If PCV20 is not available, adults can receive PCV15 followed by PPSV23 2
• For immunocompetent adults aged ≥65 years: administer PCV15, then PPSV23 at least 1 year later 2
• For adults with immunocompromising conditions, CSF leak, or cochlear implant: administer PCV15, then PPSV23 at least 8 weeks later 2

Special Populations

• Adults aged 19-64 years with immunocompromising conditions, CSF leaks, or cochlear implants should receive a single dose of PCV20 5
• High-risk individuals (functional or anatomic asplenia, HIV infection, immunosuppressive conditions) should receive revaccination once if 5 years have elapsed since the first dose 5
• Hematopoietic stem cell transplant (HSCT) recipients require a special 4-dose schedule: 3 doses of PCV20 given 4 weeks apart starting 3-6 months after HSCT, followed by a fourth dose ≥6 months after the third dose or ≥12 months after HSCT, whichever is later 2, 5

Important Clinical Considerations

• PCV20 can be administered at the same visit as other age-appropriate vaccines (including Shingrix) at different anatomic sites 5
• Always check prior pneumococcal vaccination history before administering vaccines to avoid unnecessary doses or incorrect schedules 5
• If vaccination records are unavailable, use the patient's verbal history to determine prior vaccination status rather than withholding vaccination 5
• Revaccination is contraindicated for persons who had a severe reaction to the initial dose 5

Common Pitfall to Avoid

• Do not assume that adults aged ≥65 years who received both PCV13 and PPSV23 before age 65 are fully vaccinated - they still need either PCV20 or a final dose of PPSV23 at age ≥65 years, given at least 5 years after the previous PPSV23 dose 2