Pneumococcal Vaccination Guidelines for Adults
Introduction to Pneumococcal Vaccination
- The American College of Physicians and the Advisory Committee on Immunization Practices (ACIP) recommend a single dose of PCV20 as the preferred option for adults ≥65 years who have never received pneumococcal vaccine, or alternatively PCV15 followed by PPSV23 at least 1 year later 1
Current Vaccination Recommendations
- The ACIP recommends PCV20 as the preferred option for simplicity and broader serotype coverage in adults ≥65 years who have never received pneumococcal vaccine 1
- The ACIP recommends an alternative option of PCV15 followed by PPSV23 at least 1 year later for adults ≥65 years who have never received pneumococcal vaccine 1
- The 2019 ACIP guidelines eliminated routine PCV13 for all adults ≥65 years, shifting to shared clinical decision-making only 2, 1
Key Changes in Recommendations
- PCV13-type disease incidence dropped to historically low levels through indirect effects from pediatric vaccination, with PCV13-type disease contributing only 4% of all-cause pneumonia in adults ≥65 years by 2015-2016 2
- Cost-effectiveness ratios increased dramatically from $65,000 per QALY in 2014 to $200,000-$560,000 per QALY by 2019, leading to a shift away from universal PCV13 2
Special Populations
- Adults with immunocompromising conditions require PCV13/PCV15/PCV20 first, then PPSV23 ≥8 weeks later, and should not follow shared clinical decision-making 2, 3
- Patients with CSF leaks or cochlear implants should follow the same accelerated schedule as immunocompromised patients 2, 3