New Recommendations for the Use of Pneumococcal Vaccines in Adults with Certain Health Conditions

October 2012

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
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New Recommendations for the Use of Pneumococcal Vaccines in Adults with Certain Health Conditions
Published October 2012
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit
On October 12, 2012, the Centers for Disease Control and Prevention (CDC) published new recommendations for the use of pneumococcal conjugate vaccine (PCV13/Prevnar 13, Pfizer) and pneumococcal polysaccharide vaccine (PPSV23/Pneumovax, Merck) in adults with certain health conditions, including immunocompromising ones. The questions and answers below provide additional details about these new recommendations and how PCV13 should be used in conjunction with PPSV23.
Which adults are now recommended to receive a dose of PCV13?
Adults 19 years and older who have any of the following conditions and who have not previously received PCV13 should receive one dose of PCV13 during their next vaccination opportunity:
Immunocompromising conditions (e.g., congenital or acquired immunodeficiency, HIV, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant and multiple myeloma)
Functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies and congenital and acquired asplenia)
Cerebrospinal fluid (CSF) leak
Cochlear implants
Adults with these conditions should also receive one or more doses of PPSV23.
Which patients in the groups listed above need two doses of PPSV23, and which need only one dose?
Patients ages 19 through 64 years who have any of the immunocompromising conditions listed above or have functional or anatomic asplenia, need two doses of PPSV23 spaced at least five years apart. Patients with CSF leaks or cochlear implants need only one dose of PPSV23. All patients will need a final dose of PPSV23 at age 65 years or older if the previous dose(s) were administered when the patient was younger than 65 years and at least five years have elapsed since the previous PPSV23 dose.
During an office visit, can a healthcare provider administer PCV13 and PPSV23 to an adult patient who needs both vaccines but who has had neither? If not, what is the recommended interval between doses?
PCV13 and PPSV23 should not be given at the same visit. Patients who need both PCV13 and PPSV23 and who have received neither should receive PCV13 first, followed by a dose of PPSV23 at least eight weeks later. If a second PPSV23 dose is recommended, it should be administered at least five years after the first PPSV23 dose.
What is the recommended interval between doses for adult patients who have already received one dose of PPSV23 and now need PCV13?
For patients who have already had one or more doses of PPSV23, it is recommended to wait at least one year after receipt of PPSV23 before administering PCV13. If the patient is recommended to receive a second dose of PPSV23, delay that second PPSV23 dose for at least eight weeks following PCV13 and at least five years after receipt of the first dose of PPSV23.
Do patients who were vaccinated with one or two doses of PPSV23 before age 65 need an additional dose of PPSV23 at age 65 or later?
Yes. Patients who received PPSV23 for any indication at age 64 years or younger should receive an additional dose of PPSV23 vaccine at age 65 years or older if at least five years have elapsed since their previous PPSV23 dose.
If patients who are in a recommended risk group for PPSV23 or PCV13 aren’t sure if they previously received these vaccines, should healthcare providers vaccinate?
Yes. If patients do not have a documented vaccination history for these two vaccines and their records are not readily obtainable, you should administer the recommended doses.
To obtain a copy of the newly published recommendations for the use of pneumococcal vaccines in adults, visit either of the links below:
“Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices”
For a fully formatted version, see pages 816-819 of the October 12, 2012, issue of MMWR
Both of these versions include a helpful table indicating pneumococcal vaccine recommendations based on patients’ medical conditions.


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