There are two kinds of pneumococcal vaccines: Conjugate Pneumococcal Vaccines (PCV21, PCV20, or PCV15), and the Polysaccharide Pneumococcal Vaccine (PPSV23). The following are recommendations from the Centers for Disease Control (CDC) for all adults 65 years or older.
Indications
For adults 50+ who have not previously received any pneumococcal vaccine:
Give 1 dose of PCV20, PCV21, or PCV15.
- If PCV21 or PCV20 is used, a dose of PPSV23 is NOT indicated. PCV21 or PCV20 alone is sufficient.
- If PCV15 is used, this should be followed by a dose of PPSV23 at least one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.
For adults 65+ who have only received a PPSV23:
Give 1 dose of PCV20, PCV21 or PCV15.
- The PCV15, PCV21 or PCV20 dose should be administered at least one year after the most recent PPSV23 vaccination.
- Regardless if PCV15, PCV20 or PCV21 is given, an additional dose of PPSV23 is not recommended since it has already been received.
For adults 65+ who have only received PCV13:
Give 1 dose of PCV20 or PCV21 at least one year after PCV13 vaccination.
Contraindications and Precautions
- Do not give either pneumococcal vaccine to patients with a history of serious reaction (eg, anaphylaxis) after a previous dose or to a vaccine component.
- Moderate or severe acute illness with or without fever
- Minor illnesses with or without fever are not contraindications.
Vaccine Dosing and Administration
- Administer 0.5 mL PCV20, PCV21, or PCV15 intramuscularly (22–25 g; needle length according to the patient’s age/body mass [1–1½”]).
- Administer 0.5 mL PPSV23 either intramuscularly (22–25 g; needle length according to the patient’s age/body mass [1–1½”]) or subcutaneously (23–25 g, 5/8″ needle).
- Can be given concurrently with other vaccines at different sites.
Side Effects
- Soreness, redness at injection site lasting 1–2 days
- Joint pains
- Muscle aches
- Tiredness
- Headache
Talking Points with Patients
- Streptococcus pneumoniae bacteria are commonly found in the upper respiratory tract of most people.
- Pneumococcal disease occurs most often in older people and in those with a predisposing condition (eg, pulmonary disease, asplenia/ lack of a spleen).
- Pneumococcal disease may occur in lungs (pneumonia), brain (meningitis) or blood (bacteremia).
- There are 40,000 cases of pneumococcal meningitis and bacteremia in US annually.
- Older adults are less likely to become infected with pneumococcal disease when children with whom they are in contact (eg, grandchildren) are also vaccinated.
- There are two types of pneumococcal vaccines: Conjugate Pneumococcal Vaccines (PCV21, PCV20, and PCV15), and the Polysaccharide Pneumococcal Vaccine (PPSV23).
- PCV21 protects protect against more types of disease-causing pneumococcal bacteria than PCV20 and PCV15.
- Medicare covers the cost of PPSV23, and PCV20, PCV21, PCV15, and its administration.