My patient is 35 and is scheduled for a splenectomy. He has never had a pneumococcal vaccine. What do I do?

The patient should be vaccinated at least 2 weeks before the splenectomy, if feasible. If not, vaccinate as soon as possible. Depending upon products available, he has two options:

• One dose of PCV20 alone, or
• One dose of PCV15 followed by a dose of PPSV23 (consider giving PPSV23 as soon as 8 weeks later)

CDC recommends that, if using the PCV15 and PPSV23 series, a minimum interval of 8 weeks can be considered for adults with an immunocompromising condition (including asplenia), cochlear implant, or cerebrospinal fluid leak to minimize the risk for IPD caused by serotypes unique to PPSV23 in these vulnerable groups.