Pneumonia Vaccines for Adults – PCV-13 and PPSV-23

Adults ≥65 years of age, including immunocompetent adults, are at increased risk for pneumococcal infection and should be vaccinated against the disease with a sequential regimen of PCV13 (Prevnar 13®and PPSV23 (Pneumovax® 23). 200 204

ACIP and other experts recommend that all adults ≥65 years of age who are unvaccinated or have unknown vaccination status should receive a dose of PCV13 (Prevnar 13®) followed by a dose of PPSV23 (Pneumovax® 23) 6–12 months later. 200 204

Adults ≥65 years of age who have not received PCV13 (Prevnar 13®) but previously received PPSV23 (Pneumovax® 23) at <65 years of age should receive a dose of PCV13 (Prevnar 13®) at least 1 year after the most recent dose of PPSV23 (Pneumovax® 23). 200 204 These individuals should then be revaccinated with a dose of PPSV23 (Pneumovax® 23) 6–12 months after the PCV13 (Prevnar 13®) dose and at least 5 years after the previous PPSV23 (Pneumovax® 23) dose. 200 204

Adults ≥65 years of age who have not received PCV13 (Prevnar 13®) but previously received PPSV23 (Pneumovax® 23) at ≥65 years of age should receive a dose of PCV13 (Prevnar 13®) at least 1 year after the most recent PPSV23 (Pneumovax® 23) dose. 200 204 No additional doses of PPSV23 (Pneumovax® 23) recommended. 200 204

Adults ≥65 years of age who previously received PCV13 (Prevnar 13®) at <65 years of age but have not received PPSV23 (Pneumovax® 23) should receive a dose of PPSV23 (Pneumovax® 23) 6–12 months after the PCV13 (Prevnar 13®) dose. 200

Adults ≥65 years of age who previously received PCV13 (Prevnar 13®) and PPSV23 (Pneumovax® 23) at <65 years of age should be revaccinated with a dose of PPSV23 (Pneumovax® 23) 6–12 months after the PCV13 (Prevnar 13®) dose and at least 5 years after the previous PPSV23 (Pneumovax® 23) dose. 200

SUMMARY:  Adults ≥65 years old who previously received ≥1 dose of PPSV23 should also receive PCV13, but at least one year after the last dose of PPSV23.

For those receiving the pneumococcal vaccine for the first time, PCV13 should be given first, followed 6-12 months later by PPSV23.

PCV13 can be given at the same time as an inactivated influenza vaccine. Currently, Medicare only pays for one lifetime dose of a pneumococcal vaccine for healthy patients.
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Vaccine schedules for adults (from DynaMed, accessed Oct 2016)

  •  general principles
    • pneumococcal vaccination indicated for adults ≥ 65 years old, and adults aged 19-64 years with specific indications
    • vaccination in adults includes 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13) and 1-3 doses of 23-valent pneumococcal polysaccharide vaccine (PPSV23, PPV-23)
    • administer PCV13 and PPSV23 when indicated to adults with incomplete or unknown pneumococcal vaccination history
    • no additional dose of PPSV23 recommended in adults given dose of PPSV23 at ≥ 65 years old
    • in patients requiring both PCV13 and PPSV23
      • give PCV13 first
      • do not give PCV13 and PPSV23 at same visit
    • recommended intervals
      • give PCV13 ≥ 1 year after any previous dose of PPSV23
      • give PPSV23 ≥ 1 year after any previous dose of PCV13
      • in adults with immunocompromising conditions, anatomical or functional asplenia, cerebrospinal fluid leak, or cochlear implant
        • ≥ 8 weeks between PCV13 and PPSV23
        • ≥ 5 years between doses of PPSV23
    • routine immunization not recommended for American Indians or Alaska Natives or other adults without indications
    • consider immunization for American Indians or Alaska Natives or other adults who live in areas with increased risk for invasive pneumococcal disease
  •  for immunocompetent adults ≥ 65 years old
    • with no previous PCV13 or PPSV23 vaccination
      • give PCV13
      • give PPSV23 after ≥ 1 year (no additional doses of PPSV23 required)
    • with no previous PCV13 vaccination
      • if PPSV23 vaccination at ≥ 65 years old, give 1 dose PCV13 ≥ 1 year after PPSV23 to complete vaccination
      • if ≥ 1 PPSV23 vaccination at < 65 years old
        • give PCV13 ≥ 1 year after most recent dose of PPSV23
        • give PPSV23 ≥ 1 year after most recent dose of PCV13 and ≥ 5 years after most recent dose of PPSV23 to complete vaccination
    • with previous PCV13 vaccination, but no PPSV23 vaccination prior to age 65 years, give PPSV23 ≥ 1 year after PCV13 to complete vaccination
    • with previous PCV13 vaccination and ≥ 1 PPSV23 vaccination prior to age 65 years, give PPSV23 ≥ 1 year after most recent dose of PCV13 and ≥ 5 years after most recent dose of PPSV23 to complete vaccination
  •  for adults ≥ 19 years old with immunocompromising conditions or anatomical or functional asplenia
    • indications for vaccination
      • immunocompromising conditions
        • congenital or acquired immunodeficiency
        • HIV infection
        • chronic renal failure
        • nephrotic syndrome
        • leukemia
        • lymphoma
        • Hodgkin disease
        • generalized malignancy
        • multiple myeloma
        • solid organ transplantation
        • iatrogenic immunosuppression
      • anatomical or functional asplenia
        • sickle cell disease and other hemoglobinopathies
        • congenital or acquired asplenia
        • splenic dysfunction
        • splenectomy
    • recommended dosing
      • in patients with no previous PCV13 or PPSV23
        • give PCV13, followed by PPSV23 ≥ 8 weeks later
        • give second dose of PPSV23 ≥ 5 years after first dose of PPSV23
      • in patients with no previous PCV13, but 1 previous dose of PPSV23
        • give PCV13 ≥ 1 year after PPSV23
        • give second dose of PPSV23 ≥ 8 weeks after PCV13 and ≥ 5 years after first dose of PPSV23
      • in patients with no previous PCV13, but 2 previous doses of PPSV23, give PCV13 ≥ 1 year after most recent dose of PPSV23
      • in patients with previous PCV13, but no previous PPSV23
        • give PPSV23 ≥ 8 weeks after PCV13
        • give second dose of PPSV23 ≥ 5 years after first dose of PPSV23
      • in patients with previous PCV13 and 1 previous dose of PPSV23, give second dose of PPSV23 ≥ 8 weeks after PCV13 and ≥ 5 years after first dose of PPSV23
      • additional considerations
        • if most recent dose of PPSV23 given at < 65 years old, give dose of PPSV23 ≥ 8 weeks after PCV13 and ≥ 5 years after first dose of PPSV23
        • give pneumococcal vaccines ≥ 2 weeks before immunosuppressive therapy or elective splenectomy
        • give vaccination as soon as possible to adults newly diagnosed with symptomatic or asymptomatic HIV infection
  •  for adults ≥ 19 years old with cerebrospinal fluid leaks or cochlear implants
    • give PCV13, followed by PPSV23 ≥ 8 weeks later
    • no additional PPSV23 dose indicated if patient < 65 years old
    • if PPSV23 given at < 65 years old, at ≥ 65 old give another dose of PPSV23 ≥ 5 years after last dose of PPSV23
  •  for adults aged 19-64 years who have chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, diabetes mellitus, or who smoke cigarettes
    • give PPSV23
    • at age ≥ 65 years
      • give PCV13 ≥ 1 year after PPSV23
      • give another dose of PPSV23 ≥ 1 year after PCV13 and ≥ 5 years after last dose of PPSV23
  • Reference – MMWR Morb Mortal Wkly Rep 2016 Feb 5;65(4):88 full-text
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