PCV13 (Pneumococcal Conjugate) Vaccine
Recommendations, Scenarios and Q&As for health care professionals about PCV13 for immunocompromised adults
Recommendations for Adults with no Previous Pneumococcal Vaccinations
The Advisory Committee on Immunization Practices (ACIP) recommends that adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later (see Table 1 below). Subsequent doses of PPSV23 should follow current PPSV23 recommendations for high risk adults. Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19 through 64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. A second dose of PPSV23 is not recommended for persons 19 through 64 years of age with cochlear implants or CSF leaks. Additionally, those who received one or more doses of PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or older if at least 5 years have elapsed since their previous PPSV23 dose. If a dose of PPSV23 was received at age 65 years or later, no additional doses of PPSV23 are recommended.
Recommendations for Adults with Previous Pneumococcal Polysaccharide Vaccinations (PPSV23)
Adults 19 years of age or older with the aforementioned conditions (functional or anatomic asplenia, immunocompromising conditions, or those with CSF leaks or cochlear implants) who have previously received one or more doses of PPSV23 should be given a dose of PCV13 one or more years after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23.
|Risk Group||Underlying Medical Condition||PCV13||PPSV23*|
|Recommended||Recommended||Revaccination at 5 years after first dose|
|Immunocompetent persons||Chronic heart disease†||✓|
|Chronic lung disease§||✓|
|Chronic liver disease||✓|
|Persons with functional or anatomic asplenia||Sickle cell disease/other hemoglobinopathies||✓||✓||✓|
|Congenital or acquired asplenia||✓||✓||✓|
|Immunocompromised persons||Congenital or acquired immunodeficiencies¶||✓||✓||✓|
|Chronic renal failure||✓||✓||✓|
|Solid organ transplant||✓||✓||✓|
- *All adults 65 years of age or older should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine
- †Including congestive heart failure and cardiomyopathies
- §Including chronic obstructive pulmonary disease, emphysema, and asthma
- ¶Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
- ‡Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy
Common Patient Scenarios
Scenario 1: A 24 year old sees his doctor for a routine office visit. He has asthma and has not previously received any pneumococcal vaccines. Administer vaccines as follows:
- 1 dose of PPSV23 now, at age 24
- 1 dose of PPSV23 at age 65
Note: Asthma is not an indication for adult administration of PCV13 unless the patient has received long-term systemic corticosteroids. This adult has an indication to receive a single dose of PPSV23 now. An additional dose of PPSV23 would be given at age 65 years or older.
Scenario 2: A 28 year old woman with HIV infection received one dose of PPSV23 one year ago. Administer vaccines as follows:
- 1 dose of PCV13 now because one year has passed since receipt of PPSV23
- A second dose of PPSV23 at age 32 (if it’s been ≥5 years since previous PPSV23 and ≥8 weeks since PCV13 dose
- A third dose of PPSV23 at age 65
Scenario 3: A 42 year old man with cochlear implants who has not previously received any pneumococcal vaccines. Administer vaccines as follows:
- 1 dose of PCV13 now, at age 42
- 1 dose of PPSV23 at least 8 weeks after a dose of PCV13
- A second dose of PPSV23 at age 65
Questions and Answers
How did the Advisory Committee on Immunization Practices (ACIP) make the decision to recommend PCV13 for adults with certain medical conditions?
The evidence for PCV13 vaccination of adults with immunocompromising conditions was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. ACIP considered available studies to inform their decision-making regarding recommending PCV13 for adults with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants.
Can PPSV23 and PCV13 be administered at the same office visit?
No. If PCV13 is indicated, administer it if at least 1 year has passed since the previous dose of PPSV23 or if no doses of PPSV23 have previously been received. Then wait at least 8 weeks to administer PPSV23 if no previous doses of PPSV23 have been received. If a previous dose of PPSV23 has been received and there is an indication for the second PPSV23 dose before age 65, wait 5 years since the previous dose of PPSV23 to administer the next dose of PPSV23. Then administer a third dose of PPSV23 at or after 65 years if it has been 5 years since the previous dose.
If an adult has already gotten one or more doses of PPSV23, when should they get PCV13, if indicated?
If indicated, PCV13 should be administered at least 1 year after the previous dose of PPSV23 was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23.
Should the dose of PCV13 be repeated if given less than 1 year after a dose of PPSV23? If yes, what is the interval between doses?
Yes, the dose of PCV13 should be repeated and given 1 year or later after a dose of PPSV23.
How many doses of PPSV23 can an adult get in a lifetime? Who/when?
Some adults may be recommended to receive up to 3 doses of PPSV23 in a lifetime. Two doses of PPSV23, given 5 years apart, are indicated for adults with functional or anatomic asplenia and immunocompromising conditions. Those adults should then receive a third dose of PPSV23 at or after 65 years, as long as it's been at least 5 years since the previous dose.
An adult (19 years) at high risk for IPD received a dose of PCV13 at 18 years 11 months of age. This is their only dose – no previous doses of PCV13. Does this dose count as the single dose indicated for at risk adults? If so, does the age of vaccination matter? Would the dose(s) count even if given at younger ages?
This dose would count as a single dose of PCV13 indicated for those within high risk groups. The dose of PCV13 would still count if given at younger ages.
Are there recommendations for use of PCV13 in healthy adults?
There are currently no recommendations for routine use of PCV13 in healthy adults. ACIP has reviewed the available studies and concluded that they are not sufficient to warrant a recommendation for all adults 50 years of age or older. ACIP will continue to review relevant evidence as it becomes available. Studies are underway that will help inform that decision.
What information is needed before ACIP can recommend PCV13 for routine use in adults?
The ACIP is waiting on two specific pieces of information that will fill the gaps in evidence:
- Results from a large clinical trial underway in the Netherlands that is studying the effectiveness of PCV13 against pneumococcal pneumonia among adults, and
- Data that will tell us if use of the vaccine in children also prevents disease among adults. These are considered to be critical data elements that are required to inform an ACIP vote.
What does FDA licensure mean for physicians?
FDA has licensed PCV13 for use in adults 50 and older as a single dose. Physicians can use the vaccine for people fifty and older consistent with the labeled indication. An ACIP recommendation is not needed for a clinician to administer PCV13 according to its FDA-approved indication.
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