What is the recommended pneumococcal (pneumonia) vaccination schedule for a 56-year-old high-risk patient with a history of underlying health conditions in Alberta?

Pneumococcal Vaccination for a 56-Year-Old High-Risk Patient in Alberta

For a 56-year-old high-risk patient in Alberta, administer either a single dose of PCV20 alone (preferred for simplicity) or PCV15 followed by PPSV23 at least 1 year later (or 8 weeks later if immunocompromised). 1

Determining High-Risk Status

First, identify the specific high-risk condition(s), as this determines both eligibility and timing intervals:

Chronic Medical Conditions (1-year interval between vaccines):

• Chronic heart disease (congestive heart failure, cardiomyopathies) 1
• Chronic lung disease (COPD, emphysema, asthma) 1
• Chronic liver disease 1
• Diabetes mellitus 1
• Chronic renal failure 1
• Alcoholism 1
• Current cigarette smoking 1

Immunocompromising Conditions (8-week interval between vaccines):

• HIV infection 1
• Congenital or acquired immunodeficiencies 1
• Asplenia or sickle cell disease 1
• Active malignancy (leukemia, lymphoma, multiple myeloma, Hodgkin disease) 1
• Solid organ transplant 1
• Iatrogenic immunosuppression (long-term systemic corticosteroids, chemotherapy) 1
• Nephrotic syndrome 1

Anatomic/Functional Conditions (8-week interval):

• Cochlear implant 1
• Cerebrospinal fluid leak 1

Vaccination Algorithm

Option 1: PCV20 Alone (Preferred)

Administer a single 0.5 mL dose of PCV20 intramuscularly in the deltoid muscle. 1, 2 This completes the pneumococcal vaccination series—no additional doses are needed unless the patient becomes severely immunocompromised later. 2

Advantages: Single-dose regimen ensures completion, provides coverage against 20 serotypes, eliminates need for follow-up appointment, and avoids risk of PPSV23-induced hyporesponsiveness. 2, 3

Option 2: PCV15 + PPSV23 Series

Administer PCV15 now, followed by PPSV23: 1

• If chronic medical condition only: PPSV23 at ≥1 year after PCV15 1
• If immunocompromising condition, CSF leak, or cochlear implant: PPSV23 at ≥8 weeks after PCV15 1

Critical caveat: If PCV15 is chosen, PPSV23 must follow to complete the series—PCV15 alone is insufficient protection. 2 The shorter 8-week interval for immunocompromised patients reflects greater urgency for protection in those at highest risk for invasive pneumococcal disease. 4

Special Considerations for Immunocompromised Patients

For patients with immunocompromising conditions, the 8-week minimum interval between PCV15 and PPSV23 is mandatory rather than the standard 1-year interval used for chronic medical conditions. 1, 4 This accelerated schedule provides earlier complete protection while maintaining adequate immune priming. 4

A second dose of PPSV23 is recommended 5 years after the first PPSV23 dose for immunocompromised adults who received their first dose before age 65. 1, 4 This does not apply to patients receiving PCV20 alone. 2

Administration Details

• Route: Intramuscular or subcutaneous injection into the deltoid muscle 5
• Dose: 0.5 mL 5
• Do not co-administer: PCV and PPSV23 cannot be given on the same day 4
• Defer if: Patient has moderate or severe acute illness 5

What Happens at Age 65?

Review vaccination status when the patient turns 65: 2

• If PCV20 was given: No additional pneumococcal vaccines are typically needed 2
• If PCV15 + PPSV23 series was completed before age 65: No additional doses are needed if PPSV23 was given at age ≥65 years 1, 4
• If PPSV23 was given before age 65: Administer another dose of PPSV23 at age ≥65 years if at least 5 years have passed 4

Common Pitfalls to Avoid

Do not administer PPSV23 before PCV in vaccine-naïve patients, as prior PPSV23 diminishes the immune response to subsequent PCV13 or PCV20 administration. 6, 3 The conjugate vaccine must come first to optimize immune memory. 2

Do not give multiple PPSV23 boosters beyond recommendations. After the dose administered at age ≥65 years, no additional PPSV23 doses should be given. 1, 4 The exception is immunocompromised patients who may receive a second PPSV23 dose 5 years after the first if the first dose was given before age 65. 1, 4

Do not delay vaccination waiting for complete medical records—use verbal history and proceed with vaccination if indicated. 4

Documentation

Document clearly which vaccine was administered and when, to avoid unnecessary future doses and ensure proper completion of the series at age 65. 4