Two new pneumococcal conjugate vaccines (PCV15 and PCV20) are now recommended as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP no longer recommends PCV13 for adults. When PCV15 is used routinely, it should be used in series with PPSV23 given one year later.
For adults eligible for pneumococcal vaccine as a result of age or a high-risk condition who have no or unknown history of pneumococcal conjugate vaccination, the same vaccination schedule options apply to all of them: either give one dose of PCV20 alone, or give a dose of PCV15 followed by a dose of PPSV23 one year later (with a minimum interval option of 8 weeks for people with immunocompromise, CSF leak, or cochlear implant). People age 19 through 64 with immunocompromising and non-immunocompromising underlying medical conditions and other risk factors for pneumococcal disease no longer have separate recommendations for different types of vaccines or numbers of doses.
Details of the recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104a1-H.pdf. These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html.
Immunize.org has developed standing orders for pneumococcal vaccination of adults at www.immunize.org/catg.d/p3075.pdf.
Last reviewed:
July 26, 2022
All people age 19 through 64 with the following medical conditions who have no history of pneumococcal vaccination or an unknown pneumococcal vaccination history should receive either a single dose of PCV20 alone or a dose of PCV15 followed by a dose of PPSV23 at least 1 year later. If using the PCV15 + PPSV23 series, clinicians can consider giving the dose of PPSV23 a minimum of 8 weeks later for more rapid protection against the serotypes unique to PPSV23 to people with CSF leak, cochlear implant, or immunocompromise (categories 7 through 17 below):
- cigarette smoking (does not include people who vape)
- alcoholism
- chronic liver disease, including cirrhosis
- chronic heart disease (e.g., congestive heart failure, cardiomyopathies), excluding hypertension
- chronic lung disease (including COPD and emphysema, and asthma)
- diabetes mellitus
- candidate for or recipient of cochlear implant
- cerebrospinal fluid (CSF) leak
- functional or anatomic asplenia (e.g., splenectomy or congenital asplenia)
- sickle cell disease and other hemoglobinopathies
- congenital or acquired immunodeficiencies (e.g., B- [humoral] or T-lymphocyte deficiency, complement deficiencies [particularly C1, C2, C3, and C4], and phagocytic disorders [excluding chronic granulomatous disease])
- generalized malignancy
- HIV infection
- Hodgkin disease, leukemia, lymphoma, and multiple myeloma
- immunosuppression due to treatment with medication, including long-term systemic corticosteroids, and radiation therapy
- solid organ transplantation; for bone marrow transplantation; see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
- chronic renal failure or nephrotic syndrome
Public health authorities working with Alaska Natives and American Indians may provide additional guidance for individuals in those communities where the overall risk of invasive pneumococcal disease is increased.
Last reviewed:
July 26, 2022
For adults 65 years and older with no prior pneumococcal vaccination or whose previous vaccination history is unknown, you have two options:
- One dose of PCV20 alone, or
- One dose of PCV15 followed by a dose of PPSV23 one year later
Last reviewed:
July 26, 2022
Under the new recommendations, adults who have ever had at least one dose of PPSV23 do not need another dose of PPSV23 after turning 65. They have two options:
- One dose of PCV20, or
- One dose of PCV15
Last reviewed:
July 26, 2022
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.
Last reviewed:
July 26, 2022
People with anatomic asplenia should follow the same recommendations as described for people with immunocompromising conditions. CDC currently recommends that people with immunocompromising conditions who have already received PCV13 should continue to follow the PPSV23 pneumococcal vaccination schedule recommended for people who have had PCV13. Adults with immunocompromising conditions who are younger than age 65 and who have already had PCV13 should receive one dose of PPSV23 at least 8 weeks after the dose of PCV13, then a second dose of PPSV23 at least 5 years later. If the second dose is administered before the age of 65, then a final (3rd) dose of PPSV23 is recommended at least 5 years later, on or after the 65th birthday.
If PPSV23 is due but is unavailable, and PCV20 is available, PCV20 may be given at the visit. No further doses of any type of pneumococcal vaccine are recommended after PCV20 is given.
Last reviewed:
July 26, 2022
CDC says that PCV20 may be used instead of PPSV23 if PPSV23 is unavailable. If your clinic has PCV20 but does not have PPSV23 available at the vaccination visit, do not miss the opportunity to vaccinate. Give a single dose of PCV20.
No future doses of PPSV23 or any other pneumococcal vaccine are currently recommended following a dose of PCV20, even if the patient is younger than age 65.
Last reviewed:
July 26, 2022
Nothing. People who have had PCV13 and PPSV23 after the 65th birthday are not currently recommended to receive any additional doses of pneumococcal vaccine.
Last reviewed:
July 26, 2022
The patient may be given one dose of PCV20 or one dose of PCV15. CDC does not recommend additional doses of PPSV23 for a person who received a dose of PPSV23 on or after age 65 years, regardless of the interval since vaccination.
Last reviewed:
July 26, 2022
No. All adults age 65 years and older without a prior PCV vaccination are now routinely recommended to receive either PCV20 alone or a 2-dose series of PCV15 followed by PPSV23 one year later. PCV13 is no longer recommended for adults.
Last reviewed:
July 26, 2022
No. All adults for whom pneumococcal vaccination is recommended due to age (65 or older) or an underlying condition (age 19 through 64) are now recommended to receive a conjugate vaccine. Prior recipients of PPSV23 may now receive either PCV20 or PCV15 at least 1 year after the dose of PPSV23. Adults who have had PCV13 should receive PPSV23 as recommended for them before the introduction of PCV15 and PCV20, based on age or risk factors, as described elsewhere.
Last reviewed:
July 26, 2022
Yes. Adalimumab is a potent anti-inflammatory drug that blocks the activity of tumor necrosis factor (TNF). Adalimumab is considered immunosuppressive because serious infections have been reported in people taking the drug, including tuberculosis and infections caused by viruses, fungi, or bacteria. A person taking adalimumab or other drugs that affect TNF activity (such as infliximab [Remicade], certolizumab pegol [Cimzia], golimumab [Simponi], or etanercept [Enbrel]) should be considered to have immunosuppression and receive either PCV20 alone or a 2-dose series of PCV15 followed by PPSV23. Clinicians can consider giving PPSV23 as soon as 8 weeks after PCV15 in this case, in order to accelerate protection against strains of pneumococcus unique to PPSV23.
Last reviewed:
July 26, 2022
No. If there is no longer a CSF leak, neither vaccine is recommended, unless there is another risk factor for invasive pneumococcal disease or an age-based indication.
Last reviewed:
July 26, 2022
No. Beta thalassemia minor is a hemoglobinopathy, but compared to sickle cell disease, these patients have less risk for functional asplenia, and, therefore a reduced risk for invasive pneumococcal disease.
Last reviewed:
July 26, 2022
No. However, adults who received PCV13 should complete their recommended PPSV23 vaccination 1 year after PCV13. If PPSV23 is not available when the vaccination is due, but PCV20 is available, PCV20 may be given.
Last reviewed:
July 26, 2022
What you describe is an excellent strategy for administration of pneumococcal vaccines to people age 65 years and older. ACIP does not define “one year” but this is assumed to be one calendar year. Receiving PPSV23 a few days or weeks earlier than one calendar year after PCV13 or PCV15 is not a medical problem. However, it could be a problem for reimbursement since Medicare will only pay for both a PCV vaccine and a PPSV23 vaccine if they are given at least 11 months apart. Private insurance may have similar rules. Here is the wording from the Centers for Medicare and Medicaid (CMS): “An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months have passed following the month in which the last pneumococcal vaccine was administered).”
Last reviewed:
July 26, 2022
Studies have shown that administering a pneumococcal conjugate vaccine first leads to a better immune response to serotypes common to both vaccines when the polysaccharide vaccine (PPSV23) is given at a later date. For this reason, the Advisory Committee on Immunization Practices (ACIP) recommends that pneumococcal vaccine-naive adults receive pneumococcal conjugate vaccines either alone (PCV20) or first in a sequence (PCV15 first, followed by PPSV23). A provider who stocks only PPSV23 should consider referring such patients elsewhere to receive a conjugate vaccine, if feasible. A patient due for a conjugate vaccine who receives PPSV23 first may receive either the PCV15 or PCV20 vaccine at least one year later.
Last reviewed:
July 26, 2022
For people with immunosuppression, ACIP recommends 1 dose of PCV20 or one dose of PCV15 followed by a dose of PPSV23 one year later (can consider a minimum 8-week interval for immunocompromised adults). Meningococcal serogroup B vaccine (MenB) is not specifically recommended for immunosuppressed people. However, a patient who is age 16 through 23 years and immunosuppressed may receive routine MenB vaccination of either a 2-dose series of Bexsero (GSK) 4 weeks apart, or a 3-dose series of Trumenba (Pfizer) at 0, 1 month, and 6 months apart.
Last reviewed:
July 26, 2022
Mesalamine (mesalazine) is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so it’s use would not place a person at increased risk of invasive pneumococcal disease.
Last reviewed:
July 26, 2022
Multiple sclerosis is not a contraindication to any vaccine, including pneumococcal vaccines.
Last reviewed:
July 26, 2022
