Pneumococcal Vaccination Guidelines for Adults Aged 65 and Older
Current Recommendations
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommends shared clinical decision-making regarding administration of either PCV21 or PCV20 for adults aged ≥65 years who have received both PCV13 and PPSV23, with administration at least 5 years after the last pneumococcal vaccine dose 1
- If a decision to administer PCV21 or PCV20 is made, a single dose should be given ≥5 years after the last pneumococcal vaccine dose, as recommended by the ACIP 1, 2
- The ACIP guidelines state that shared clinical decision-making is recommended for adults aged ≥65 years who have completed their recommended vaccine series with both PCV13 and PPSV23 3
Factors to Consider in Decision-Making
- The patient's risk for pneumococcal disease due to underlying medical conditions should be evaluated when considering additional vaccination, according to the ACIP 3
- Time elapsed since the patient's last pneumococcal vaccination (≥5 years is preferred) is an important consideration, as stated by the ACIP 3
- Risk for exposure to pneumococcal serotypes contained in newer vaccines should be assessed, as recommended by the ACIP 3
Economic Considerations
- Economic models show variable cost-effectiveness for additional PCV20 vaccination after complete series, ranging from $93,000 to $970,000 per QALY gained depending on time since previous vaccination, according to the ACIP 3, 5
- For immunocompromised adults, economic models showed results ranging from $40,000 per QALY gained to potentially worse health outcomes, as reported by the ACIP 5
Implementation Guidance
- If deciding to administer PCV21 or PCV20, it should be given as a single dose ≥5 years after the last pneumococcal vaccine dose, as recommended by the ACIP 1, 2
Common Pitfalls and Caveats
- Avoid unnecessary revaccination if the time since last pneumococcal vaccination is less than 5 years, as stated by the ACIP 3, 6
- The benefit of additional vaccination may be less substantial in patients who have already received both PCV13 and PPSV23 compared to those who are vaccine-naïve, according to the ACIP 3