Pneumococcal Vaccination Guidelines

Evidence for Increased Risk in Unvaccinated Individuals

The Advisory Committee on Immunization Practices (ACIP) strongly recommends pneumococcal vaccination for all adults aged ≥65 years and adults aged 19-64 years with certain risk conditions, as pneumococcal vaccines have been shown to be safe and effective in preventing invasive pneumococcal disease and pneumonia in adults 1, 2
The 23-valent pneumococcal polysaccharide vaccine (PPSV23) has demonstrated effectiveness in the range of 56-81% in preventing invasive pneumococcal disease in various high-risk populations 3, 4
In immunocompetent patients over age 65, pneumococcal vaccination effectiveness has been documented to be 75% against invasive pneumococcal disease 3, 4

Pneumococcal vaccination has been associated with a 22% reduction in all-cause mortality among adults with cardiovascular disease or very high cardiovascular risk 1

Certain populations are at particularly high risk for pneumococcal disease and should prioritize vaccination, including persons with chronic heart disease, chronic lung disease, diabetes mellitus, alcoholism, chronic liver disease, current cigarette smokers, persons with functional or anatomic asplenia, and immunocompromised individuals 1, 5, 6, 7
Current cigarette smokers have a 2.8-4.1 times increased risk for invasive pneumococcal disease 1

For adults ≥65 years with no prior pneumococcal vaccination, a single dose of PCV21, PCV20, or PCV15 is recommended, with a dose of PPSV23 to follow at least 1 year later if PCV15 is used 2
For adults 19-64 years with risk factors, a single dose of PCV20 alone or PCV15 followed by PPSV23 at least 1 year later is recommended 1
For immunocompromised adults, if PCV15 is used, PPSV23 should follow at least 8 weeks later 2

Failing to assess vaccination status at hospital admission or during outpatient visits can lead to missed opportunities for vaccination 8, 9
Not recognizing that cigarette smoking is an independent risk factor for pneumococcal disease can lead to inadequate vaccination recommendations 1, 5
Overlooking the need for pneumococcal vaccination in younger adults with chronic medical conditions can increase their risk of pneumococcal disease 1