Recommendations, Scenarios and Q&As for Healthcare Professionals about PCV13 for Adults

Recommendations

Recommendations for Adults with No Previous Pneumococcal Vaccinations

CDC recommends that all adults 65 years of age or older receive a dose of pneumococcal conjugate vaccine (PCV13 or Prevnar13®) followed by a dose of pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) at least 1 year later. You should not administer PCV13 and PPSV23 on the same day.

CDC also recommends pneumococcal vaccination for adults 19 years of age or older with

  • Immunocompromising conditions
  • Functional or anatomic asplenia
  • Cerebrospinal fluid (CSF) leaks
  • Cochlear implants

These adults should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later. Subsequent doses of PPSV23 should follow current pneumococcal recommendations for adults at increased risk for pneumococcal disease. Specifically, CDC recommends a second PPSV23 dose 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. However, with some conditions (e.g., cochlear implants, CSF leaks), CDC does not recommend a second dose of PPSV23 for persons 19 through 64 years of age. Additionally, those who received one or more doses of PPSV23 before age 65 years for any indication should receive one final dose of the vaccine at age 65 years or older once at least 5 years have elapsed since their most recent PPSV23 dose.

Pneumococcal Vaccine Timing for Adults pdf icon[4 pages] provides a summary of this detailed guidance.

Recommendations for Adults with Previous PPSV23 Vaccinations

Adults 65 years of age or older who have not previously received PCV13 should receive a dose of PCV13. Give the dose of PCV13 at least 1 year after the most recent PPSV23 dose. Additionally, adults 65 years or older should receive 1 dose of PPSV23 after age 65 years old regardless of their previous PPSV23 vaccination history. Doses of PPSV23 should be spaced 5 years apart from each other.

Adults 19 years of age or older who previously received one or more doses of PPSV23 should receive a dose of PCV13 at least one year after administration of the most recent PPSV23 dose if they have

  • Functional or anatomic asplenia
  • Immunocompromising conditions
  • CSF leaks
  • Cochlear implants

For those who require an additional dose of PPSV23, administer it no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.

Pneumococcal Vaccine Timing for Adults pdf icon[4 pages] provides a summary of this detailed guidance.

Common Patient Scenarios

Scenario 1: A 24-year-old man sees his doctor for a routine office visit. He has asthma and has not received any pneumococcal vaccines in the past. Administer vaccines as follows:

  • 1 dose of PPSV23 now, at age 24
  • 1 dose of PCV13 at age 65
  • A second dose of PPSV23 at least 1 year after PCV13 is given

Note: Asthma, as a chronic lung disease, is an indication for pneumococcal vaccination. A dose of PPSV23 is recommended for 19–64 year olds with chronic lung disease including asthma. A dose of PCV13 would only be recommended for a 19–64 year old with asthma who is being treated with immunosuppressive drugs such as long-term systemic corticosteroids. The 24-year-old man in this scenario has an indication to receive a single dose of PPSV23 now. A dose of PCV13 would be given at age 65 years or older followed by a dose of PPSV23 one year later.

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 since one year has passed since receipt of PPSV23
  • A second dose of PPSV23 at age 32 since 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 sees his doctor for a routine office visit. He 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 the dose of PCV13
  • A second dose of PPSV23 at age 65

Scenario 4: A 66-year-old man with chronic heart disease sees his doctor for a routine office visit. He received a dose of PPSV23 at age 55. Administer vaccines as follows:

  • 1 dose of PCV13 now because his age is ≥65 and at least one year has passed since receipt of PPSV23
  • 1 dose of PPSV23 at least 1 year after the dose of PCV13 and ≥5 years after the previous PPSV23

Scenario 5: A 19-year-old woman with anatomic asplenia received a dose of PCV13 when she was 18 years 11 months of age. This is the only PCV13 dose she has ever received. Administer vaccines as follows:

  • 1 dose of PPSV23 at least 8 weeks after the dose of PCV13
  • A second dose of PPSV23 at least 5 years after the previous PPSV23
  • A final dose of PPSV23 at age 65

Note: The dose of PCV13 at 18 years 11 months of age would count as the single dose of PCV13 indicated for adults with certain medical conditions. This dose of PCV13 would still count even if it had been given at a younger age.

Questions and Answers

How did CDC make the decision to recommend PCV13 for adults?

CDC sets the adult immunization schedule based on recommendations from the Advisory Committee on Immunization Practices (ACIP). ACIP used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework to evaluate evidence for PCV13 vaccination of adults 19 years or older with immunocompromising conditions and all adults 65 years or older.

Can I administer PPSV23 and PCV13 at the same office visit?

No, never give PPSV23 and PCV13 together. The recommended order for the two vaccines, if possible, is to give PCV13 first followed by PPSV23 later. The interval between administrations depends on the age of the patient, the indication for giving it, and which vaccine you administer first. See Pneumococcal Vaccine Timing for Adults pdf icon[4 pages] for additional details.

If an adult who is 19 through 64 years of age has already gotten one or more doses of PPSV23, when should they get PCV13, if indicated?

If indicated, administer PCV13 at least 1 year after the previous dose of PPSV23. For those who require an additional dose of PPSV23, administer it at least 8 weeks after PCV13 and at least 5 years since the prior dose of PPSV23.

If an adult who is 65 years of age has already gotten one dose of PCV13 before age 65 for one of the indications, should another dose of PCV13 be given at age 65?

No. If the patient received a dose of PCV13 before age 65 for one of the indications, CDC does not recommend any additional PCV13 doses.

Should I repeat a PCV13 dose if a patient received it less than 1 year after a dose of PPSV23? If yes, what is the interval between doses?

For adults, ACIP does not recommend repeating any doses, if inadvertently administered sooner than the recommended interval. Never administer PCV13 and PPSV23 during the same visit.

If I inadvertently administer PPSV23 less than 8 weeks after PCV13, do I need to repeat the dose of either vaccine?

No, you do not need to repeat any doses. PPSV23 that follows PCV13 at less than 8 weeks may increase risk for localized reaction at the injection site, but remains a valid vaccination and you should not repeat it. The PCV13 dose also remains valid and you should not repeat it either. Never administer PPSV23 and PCV13 during the same visit.

How many doses of PPSV23 can an adult get in a lifetime? Who/when?

CDC recommends some adults receive up to 3 doses of PPSV23 in a lifetime. Adults who have functional or anatomic asplenia or immunocompromising conditions should receive two doses of PPSV23, given 5 years apart, before age 65 years. 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 most recent dose.

How many doses of PCV13 can an adult get in a lifetime? Who/when?

CDC recommends all adults receive 1 dose of PCV13, if indicated and if they have not received PCV13 previously (including childhood series). For most people, this will be as part of the routine recommendation to administer PCV13 to all adults 65 years of age or older. However, if an adult received a dose of PCV13 prior to turning 65 years of age (due to a medical indication), they do not also need to receive a dose of PCV13 when they turn 65.

Page last reviewed: December 6, 2017