From the Guidelines
For adults 65 and older who are immunocompromised, have CSF leaks, or cochlear implants, a single dose of PCV21 is recommended as the preferred option. According to the most recent guidelines from the Advisory Committee on Immunization Practices 1, adults in this age group who have not previously received any pneumococcal vaccine or have only received PCV7 can receive a single dose of PCV21, PCV20, or PCV15. However, if PCV15 is administered, a single dose of PPSV23 should be given at least 1 year later, or at least 8 weeks later for those with immunocompromising conditions, CSF leaks, or cochlear implants.
The recommendation for PCV21 is based on its ability to provide protection against a broader range of pneumococcal serotypes compared to PCV20 and PCV15 1. This is particularly important for immunocompromised individuals and those with CSF leaks or cochlear implants, who are at higher risk for invasive pneumococcal disease and its complications.
Key considerations for vaccination include:
- Previous vaccination history: The choice of vaccine and timing depend on the individual's previous pneumococcal vaccination history 1.
- Immunocompromising conditions: These individuals may require a different vaccination schedule, with a minimum interval of 8 weeks between PCV15 and PPSV23 doses 1.
- CSF leaks or cochlear implants: These conditions also require careful consideration of the vaccination schedule to ensure optimal protection 1.
Overall, the goal of pneumococcal vaccination in adults 65 and older who are immunocompromised, have CSF leaks, or cochlear implants is to provide protection against invasive pneumococcal disease and its complications, while minimizing the risk of adverse reactions and ensuring optimal immune response 1.
From the Research
Pneumonia Vaccine Recommendations for Adults 65 and Older
- The Advisory Committee on Immunization Practices (ACIP) recommends the use of 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged 19 years and older with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants 2.
- PCV13 should be administered to eligible adults in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2.
Vaccine Administration
- The ACIP recommends that PCV13 be administered to adults with immunocompromising conditions, CSF leaks, or cochlear implants, regardless of their age 2.
- Adults 65 years and older who are immunocompromised, have CSF leaks, or cochlear implants should receive PCV13 and PPSV23 as recommended by the ACIP 2.
Immunogenicity and Safety
- A study on the immunogenicity and safety of a 14-valent pneumococcal polysaccharide conjugate vaccine (PNEUBEVAX 14®) found it to be safe and immunogenic in infants 3.
- However, this study does not directly address the vaccine recommendations for adults 65 and older with immunocompromising conditions, CSF leaks, or cochlear implants.
- Another study found that the 13-valent pneumococcal conjugate vaccine (PCV13) is immunogenic in animals and suitable for use in human vaccine development 4.
Vaccination Coverage
- A retrospective cohort analysis found that pneumococcal vaccination rates among adults with immunocompromising conditions, CSF leaks, or cochlear implants are low, highlighting the need for targeted interventions to increase vaccine uptake in this vulnerable population 5.