Pneumococcal Vaccination for Patients with Pulmonary Tuberculosis

Introduction to Vaccination Recommendations

• The Centers for Disease Control and Prevention recommends that patients with pulmonary tuberculosis (PTB) receive pneumococcal conjugate vaccine (PCV) first, rather than pneumococcal polysaccharide vaccine (PPSV23) alone, to prevent pneumococcal disease 1, 2

Vaccination Sequence

• The American Academy of Family Physicians recommends giving a single dose of PCV20 as the first option for patients with PTB, which completes the vaccination series, with no need for additional doses of PPSV23 3, 4, 1
• Alternatively, the Centers for Disease Control and Prevention suggests giving PCV15 first, followed by PPSV23 at least 1 year later, for patients with PTB, considering their chronic lung disease status 3, 1, 2

Rationale for PCV First

• The Advisory Committee on Immunization Practices states that PCV should be given before PPSV23 to avoid reduced immune response to subsequent PCV doses, known as immunologic hyporesponsiveness 1, 5

Timing of Vaccination

• The World Health Organization recommends waiting for the patient's acute PTB symptoms to resolve before vaccinating, and then administering the vaccine when the patient is clinically stable 5

Special Considerations

• The Centers for Disease Control and Prevention advises against giving PPSV23 before PCV, as it may decrease vaccine effectiveness, and against delaying vaccination too long, to protect against pneumococcal pneumonia 5
• The American College of Chest Physicians notes that if PCV20 is used, no additional pneumococcal vaccines are needed, and PCV and PPSV23 should not be given on the same day 3, 1, 2