Does a patient who received the pneumococcal conjugate (PCV) 13 vaccine a few years ago require a booster dose of pneumococcal polysaccharide vaccine (PPSV23)?

Pneumococcal Vaccination After Prior PCV13

Yes, a patient who received PCV13 a few years ago requires an additional pneumococcal vaccine—specifically, either a single dose of PCV20 or PPSV23, administered at least 1 year after the PCV13 dose. 1, 2

Recommended Vaccination Strategy

The preferred approach is to administer a single dose of PCV20 at least 1 year after the PCV13 dose, which completes the pneumococcal vaccination series with no additional doses needed. 2, 3

Primary Options

• PCV20 (Preferred): Administer one dose ≥1 year after PCV13, completing the series entirely 2, 3
• PPSV23 (Alternative): Administer one dose ≥1 year after PCV13 if PCV20 is unavailable 1, 2

Rationale for PCV20 as Preferred Option

• Broader serotype coverage: PCV20 covers 20 serotypes compared to PCV13's 13 serotypes, providing protection against additional disease-causing strains 2, 3
• Simplified schedule: A single dose completes the series, eliminating the need for subsequent PPSV23 administration 2, 3
• Superior immunologic response: Conjugate vaccines like PCV20 generate T-cell dependent responses with immunologic memory, unlike polysaccharide vaccines 3
• Clinical trial evidence: Phase III trials demonstrated PCV20 is safe and immunogenic in adults previously vaccinated with PCV13, regardless of interval (6 months to 5 years) 3

Critical Timing Requirements

The minimum interval between PCV13 and the subsequent pneumococcal vaccine is 1 year for all patient populations. 1, 2, 3

Timing by Patient Category

• Immunocompetent adults (age ≥65 or with chronic conditions): ≥1 year after PCV13 1, 2
• Immunocompromised adults: ≥1 year after PCV13 (same interval applies) 2, 3
• Adults with chronic medical conditions only: ≥1 year after PCV13 1, 3

Common Pitfall to Avoid

Do not administer PCV20 or PPSV23 before the 1-year minimum interval has elapsed, as this violates ACIP recommendations and may result in suboptimal immune response. 2, 3

Age-Specific Considerations

For Adults Under Age 65

If the patient received PCV13 before age 65 and now requires completion:

• Administer PCV20 ≥1 year after PCV13 1, 3
• Review vaccination status again when the patient turns 65 years old to determine if any additional doses are indicated based on updated guidelines 1, 2

For Adults Age 65 and Older

• Administer PCV20 ≥1 year after PCV13 2, 3
• Once PCV20 is given, the pneumococcal vaccination series is complete with no additional doses needed 2, 3

Risk-Based Modifications

Immunocompromised Patients

For patients with HIV, malignancy, immunosuppressive therapy, transplant recipients, or other immunocompromising conditions:

• The same ≥1 year interval applies after PCV13 2, 3
• PCV20 is preferred as it completes the series without requiring subsequent PPSV23 2, 4
• No shorter interval is needed for immunocompromised patients when transitioning from PCV13 to PCV20 3

Chronic Medical Conditions

For patients with diabetes, chronic heart disease, chronic lung disease, chronic liver disease, or cigarette smoking:

• Administer PCV20 ≥1 year after PCV13 1, 3
• This completes the pneumococcal vaccine series 1, 3

What Happens After PCV20 Administration

Once PCV20 is administered, the pneumococcal vaccination series is complete and no additional pneumococcal vaccines are needed in most scenarios. 2, 3

Key Points

• Do not add PPSV23 after PCV20—this is unnecessary and not recommended 3
• Document that the pneumococcal vaccination series is complete 2, 4
• For patients under 65, reassess at age 65, though typically no additional doses are needed if PCV20 was given 2, 3

Alternative Scenario: If PPSV23 is Given Instead

If PPSV23 is administered ≥1 year after PCV13 (rather than PCV20):

• This completes the initial series for patients under 65 1
• However, when the patient turns 65, they may still benefit from PCV20 administration ≥5 years after the last pneumococcal vaccine dose through shared clinical decision-making 2, 3

Evidence Quality Considerations

The 2023 ACIP guidelines represent the highest quality evidence available, with formal implementation guidance from the CDC 1, 2. The recommendation for PCV20 after PCV13 is based on:

• Strong immunogenicity data showing conjugate vaccines maintain superior responses over time 5, 6
• Evidence that initial PCV13 priming establishes an immune state allowing robust recall responses to subsequent vaccination 6
• Clinical trial data demonstrating safety and efficacy of PCV20 in previously vaccinated adults 3

The 1-year interval provides better booster effects than shorter intervals (such as 6 months), with significantly higher antibody responses for most serotypes. 7