From the Guidelines
No, there has never been a recommendation to withhold PPSV23 from adults 65 and older who are immunocompromised, have CSF leaks, or cochlear implants. In fact, these specific populations are considered high-priority groups for pneumococcal vaccination, including PPSV23. According to the most recent guidelines from 2023, adults aged ≥65 years who previously have received PCV13 only are recommended to complete their pneumococcal vaccine series by receiving either a dose of PCV20 or PPSV23 with an interval of ≥1 year after the PCV13 dose 1. For adults with an immunocompromising condition, a CSF leak, or a cochlear implant, the minimum recommended interval between PCV13 and PPSV23 is 8 weeks 1.
The Advisory Committee on Immunization Practices (ACIP) continues to recommend PCV13 in series with PPSV23 for adults aged ≥19 years (including those aged ≥65 years) with immunocompromising conditions, CSF leaks, or cochlear implants 1. This approach provides broader protection against pneumococcal serotypes, which is crucial for these vulnerable populations due to their increased risk of invasive pneumococcal disease.
Key points to consider include:
- Immunocompromised individuals have a reduced ability to mount immune responses, making vaccination critical for their protection against pneumococcal infections.
- Those with CSF leaks or cochlear implants have anatomical conditions that create direct pathways for pneumococcal bacteria to cause serious infections like meningitis, underscoring the importance of vaccination in these groups.
- The recommendation for PPSV23 in these populations is based on their significantly higher risk of pneumococcal infection and potentially more severe outcomes, emphasizing the need for comprehensive vaccination strategies that include both PCV13 and PPSV23.
From the Research
PPSV23 Vaccination Recommendations
- There is no evidence to suggest that PPSV23 should not be given to adults 65 and older who are immunocompromised, have CSF leak, or cochlear implant 2.
- In fact, the Advisory Committee on Immunization Practices (ACIP) recommends routine use of 13-valent pneumococcal conjugate vaccine (PCV13) in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants 2.
- The ACIP recommendations are based on the evaluation of the benefits and risks of PCV13 vaccination of adults with immunocompromising conditions using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework 2.
Vaccination Coverage
- A retrospective cohort analysis found that pneumococcal vaccination rates among adults aged 19 to 64 years with immuno-compromising conditions, CSF leaks, or cochlear implants in the US are low, highlighting the need for targeted interventions to increase vaccine uptake in this vulnerable population 3.
- The study found that the proportion of high-risk adults who received at least one pneumococcal vaccination increased from 5.4% after 1 year of follow-up to 14.2% after 6 years of follow-up 3.
Other Vaccination Studies
- A phase 3, single-blind, randomized, active-controlled study found that a 14-valent pneumococcal polysaccharide conjugate vaccine (PNEUBEVAX 14®) was safe, immunogenic, and non-inferior to Prevenar-13® (PCV-13) when administered to infants 4.
- The study found that the multi-dose presentation of PNEUBEVAX 14® was both safe and immunogenic when administered to 6-8-week-old infants in a 6-10-14-week dosing schedule 4.