In a patient in their late 80s, are there clinical risks associated with receiving additional pneumococcal vaccine doses beyond the recommended schedule?

Receiving Additional Pneumococcal Vaccines Beyond Recommendations in Late 80s

There are documented clinical risks to receiving pneumococcal vaccines beyond the recommended schedule, particularly increased local injection-site reactions and systemic adverse events with revaccination, and no evidence of additional clinical benefit. 1

Evidence of Harm from Excess Vaccination

The FDA-approved prescribing information for PPSV23 demonstrates clear safety concerns with revaccination:

• Injection-site adverse reactions increased dramatically with revaccination (79.3%) compared to initial vaccination (52.9%) in adults ≥65 years. 1

• The proportion experiencing injection-site discomfort that interfered with or prevented usual activity, or induration ≥4 inches, was three times higher with revaccination (30.6%) versus initial vaccination (10.4%). 1

• Systemic adverse reactions were more common following revaccination (33.1%) than initial vaccination (21.7%) in subjects ≥65 years. 1

• The most common reactions included pain/soreness/tenderness (77.2%), swelling (39.8%), erythema (34.5%), headache (18.1%), asthenia/fatigue (17.9%), and myalgia (17.3%). 1

Current Guideline Recommendations for Your Age Group

The 2023 ACIP guidelines provide clear stopping points for pneumococcal vaccination:

• No additional PPSV23 doses should be administered after the dose given at age ≥65 years. 2, 3

• The ACIP explicitly states uncertainty regarding clinical benefit and safety of multiple revaccinations, which is why they do not recommend them. 3

• For immunocompetent adults in their late 80s, the maximum lifetime PPSV23 doses is 1-2 total. 3, 4

Why Additional Doses Provide No Benefit

• Current pneumococcal vaccines (PCV20, PCV21, or PCV15/PPSV23 series) are considered lifetime vaccinations with no routine booster doses recommended after series completion. 3

• The widespread use of conjugate vaccines in children has led to near-disappearance of vaccine serotypes from the population through herd immunity, making additional doses of older vaccines increasingly irrelevant. 5

• Antibody responses 12 months after PPSV23 or PCV13 are identical, with no evidence of more persistent immunity from repeated dosing. 5

Specific Clinical Risks to Avoid

Common pitfalls:

• Never receive pneumococcal vaccines on the same day, as this reduces immune response and wastes the vaccine. 3, 4

• Avoid giving multiple PPSV23 boosters beyond recommendations—there is insufficient evidence for safety with three or more doses. 3

• Post-marketing surveillance has identified serious adverse reactions including Guillain-Barré syndrome, radiculoneuropathy, thrombocytopenia, hemolytic anemia, serum sickness, and anaphylactoid reactions. 1

What You Should Do Instead

If you have already completed the recommended series (PCV13 and PPSV23 at age ≥65, or PCV20 alone):

• No additional doses are recommended or beneficial. 2, 3

• The only exception would be shared clinical decision-making with your provider to consider PCV20 if you received PCV13 and PPSV23 at least 5 years ago, though this is optional, not required. 2

If you are uncertain about your vaccination history:

• Do not delay—use verbal history and proceed with appropriate vaccination if indicated, but document clearly to avoid unnecessary future doses. 3

• Your provider can check immunization registries or previous medical records to verify your status. 3

The evidence strongly supports adhering to guideline recommendations rather than exceeding them, as additional doses increase your risk of adverse reactions without providing additional protection against pneumococcal disease.