PCV13 and PPSV23 Vaccination Guidelines
Dose Recommendations and Age Considerations
For adults ≥65 years with COPD who have never received pneumococcal vaccination, administer a single 0.5 mL dose of PCV20 as the preferred option, which provides lifetime protection without requiring additional doses. 1, 2
Primary Vaccination Options for Adults ≥65 Years
Preferred approach: Single dose of PCV20 (0.5 mL) - this is the simplest regimen with broader serotype coverage and requires no additional doses 1, 2
Alternative approach: Single dose of PCV15 (0.5 mL) followed by PPSV23 (0.5 mL) at least 1 year later 1, 2
Both PCV13 and PPSV23 are recommended for all patients older than 65 years of age according to GOLD guidelines 3
Vaccination Based on Prior History
If previously received PPSV23 before age 65:
- Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1, 4
- This completes the series - no additional doses needed 4
If previously received only PCV13:
- Administer PCV20 or PPSV23 at least 1 year after the PCV13 dose 1
If never vaccinated:
- Proceed with PCV20 immediately - do not delay vaccination waiting for records 1
Administration Method and Site of Injection
Route and Site
Route: Intramuscular (IM) injection 5
Preferred site: Deltoid muscle of the upper arm 5
Dose volume: 0.5 mL for both PCV13/PCV15/PCV20 and PPSV23 5
Critical Administration Rules
Never co-administer pneumococcal vaccines on the same day - they must be given separately 1, 2
Pneumococcal vaccines can be given simultaneously with other vaccines (like influenza) but at different injection sites 5
Use proper IM injection technique with appropriate needle length for deltoid administration 5
Special Considerations for COPD Patients
Younger COPD Patients (<65 years)
PPSV23 is recommended for younger patients with COPD as a significant comorbid chronic lung disease 3
These patients should receive the same one-time series (PCV20 alone or PCV15 followed by PPSV23 ≥1 year later), then reassess at age 65 1
Immunocompromised COPD Patients
If the patient has immunocompromising conditions (chronic renal failure, HIV, malignancies, immunosuppressive therapy):
Use shorter interval of 8 weeks (not 1 year) between PCV and PPSV23 1, 5
Administer a second dose of PPSV23 five years after the first PPSV23 dose if given before age 65 1
This accelerated schedule reflects greater urgency for protection in high-risk patients 1
Common Pitfalls to Avoid
Do not give multiple PPSV23 boosters beyond recommendations - after the dose given at age ≥65 years, no additional PPSV23 doses are indicated for immunocompetent adults 1, 2
Do not delay vaccination due to missing records - use verbal history and proceed with indicated vaccination 1
Do not administer PCV13 routinely to all adults ≥65 years - this recommendation was eliminated in 2019 and replaced with PCV15/PCV20 2
Avoid giving PPSV23 before PCV in vaccine-naïve patients - conjugate vaccines (PCV) should always come first for optimal immune response 1, 2
Evidence Quality Notes
The 1-year interval between PCV and PPSV23 for immunocompetent adults provides superior booster effects compared to shorter intervals, with research showing better immunogenicity with 1-year versus 0.5-year spacing 6. Sequential PCV13/PPSV23 vaccination demonstrates highest effectiveness (80.3%) in adults aged 65-74 years 7. Long-term data shows PCV13 maintains clinical effectiveness over 5 years, while PPSV23 effectiveness diminishes after the first year 8.