Pneumococcal Vaccination Guidelines

Background:

Streptococcus pneumonia (pneumococcus) can cause pneumonia, meningitis, bacteremia, otitis media and sinusitis, with older adults being most at risk for serious illness and death. Pneumococcal bacteria are spread via direct contact with respiratory secretions e.g., saliva or mucus. Vaccination is the best way to prevent infection. After the introduction of pneumococcal vaccinations for adults and children in the US in the early and mid 2000s, the rates of invasive pneumococcal disease decreased substantially.

Types of Vaccine:

Pneumococcal conjugate vaccines (PCVs): PCV15 | PCV20 | PCV21
Pneumococcal polysaccharide vaccine: PPSV23
Each vaccine protects against different serotypes of pneumococcal bacteria

NOTE: New formulations and changes in guidelines have occurred over the past few years which has led to confusion regarding timing and selection of vaccine types, especially in adults who have already received a single dose of PPSV23 or PCV13. The CDC has created an application (‘PneumoRecs VaxAdvisor’) specifically for individualized guidance tailored for your patient (see under “Learn More” below)

Vaccine Recommendations:

All adults age ≥ 50 years
- If PCV 20 or 21 used vaccination is considered complete, and no further doses are necessary
- If PCV 15 used, administer a dose of PPSV23 one year later OR at least 8 weeks in adults with immunocompromising conditions | cochlear implant | CSF leak

Adults aged 19-49 with certain underlying health conditions e.g, Chronic Lung, Liver or Heart Disease | Diabetes Mellitus| Asplenia | Sickle Cell Disease | Immunosuppression | Cochlear Implant | Malignancy | Alcoholism
- Depending on age and type(s) of vaccine received, patients may be recommended to receive additional pneumococcal vaccines
Adults 65 years or older have the option to get PCV20 or PCV21 to increase the number of pneumococcal serotypes covered, or they may elect not get additional pneumococcal vaccines. They can get PCV20 or PCV21 if they have received both:
- PCV13 (but not PCV15, PCV20, or PCV21) at any age and
- PPSV23 at or after the age of 65 years old

Special Considerations:

Native Americans and Alaskan Indians populations should receive PCV20 alone or PCV15 and PPSV23 in series given the high prevalence of Serotype 4 Pneumococcal disease that is not covered by PCV 21