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

Pneumococcal Conjugate Vaccine (PCV13) Recommendations

Recommendations for Adults with No Previous Pneumococcal Vaccinations

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All adults 65 years or older should receive 1 dose of pneumococcal polysaccharide vaccine (PPSV23). In addition, CDC recommends PCV13 based on shared clinical decision-making for adults 65 years or older who do not have an immunocompromising condition†, cerebrospinal fluid leak, or cochlear implant. Clinicians should consider discussing PCV13 vaccination with their older patients to decide if vaccination might be appropriate.

  • For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive PPSV23 ONLY:
    • Administer 1 dose of PPSV23.
  • For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive PCV13 AND PPSV23:
    • You should not administer PCV13 and PPSV23 on the same day.
    • Administer 1 dose of PCV13 first then give 1 dose of PPSV23 at least 1 year later.

CDC also recommends PCV13 for all adults 19 years of age or older with

  • Immunocompromising conditions
  • 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 immunocompromising conditions. However, with some conditions (i.e., 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[5 pages] provides a summary of this detailed guidance.

Footnote

† Immunocompromising conditions include: chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.

Recommendations for Adults with Previous PPSV23 Vaccinations

Adults 65 years of age or older who do not have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak and who have not previously received PCV13 may receive a dose of PCV13. Based on shared clinical decision-making, clinicians and these older adults can discuss PCV13 vaccination to decide if it is appropriate. For those who choose to receive PCV13, give the dose of PCV13 at least 1 year after the most recent PPSV23 dose. Additionally, all 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

  • 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[5 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 (optional if he and his clinician decide to based on shared clinical decision-making)
  • A second dose of PPSV23
    • At age 65 if PCV13 is not administered
    • At least 1 year after PCV13 if it is given at age 65

Note: Asthma, as a chronic lung disease, is an indication for pneumococcal vaccination. CDC recommends a dose of PPSV23 for 19–64 year olds with chronic lung disease, including asthma. CDC recommends a dose of PCV13 only 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 can be given at age 65 years or older followed by a dose of PPSV23 one year later. If PCV13 is not administered at age 65, then administer the second dose of PPSV23 at that time.

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 (optional if he and his clinician decide to based on shared clinical decision-making) because his age is ≥65 and at least one year has passed since receipt of PPSV23
  • 1 second dose of PPSV23
    • Now if PCV13 is not administered since at least 5 years have passed since receipt of PPSV23
    • If PCV13 is administered now, then wait at least 1 year after the dose of PCV13

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 she received it 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) approach or Evidence to Recommendations framework to evaluate evidence for PCV13 vaccination recommendations:

What does shared clinical decision-making about PCV13 vaccination entail?

Shared clinical decision-making allows clinicians and older adults without an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant to discuss the benefits and risks of PCV13 vaccination and determine if the vaccine is appropriate for those individual patients. Clinicians and older adults may want to consider the following when making this decision:

  • PCV13 is a safe and effective vaccine for older adults. The risk for PCV13-type disease among adults aged ≥65 years is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects (reduced population carriage and transmission). The remaining risk is a function of each individual patient’s risk of exposure to PCV13 serotypes and the influence of underlying medical conditions on the patient’s risk of developing pneumococcal disease if exposure occurs.
  • The following adults aged ≥65 years are potentially at increased risk of exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination, and providers/practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged ≥65 years who have not previously received PCV13:
    • Persons residing in nursing homes or other long-term care facilities
    • Persons residing in settings with low pediatric PCV13 uptake (use ChildVaxView Interactive! to find state and selected local area data)
    • Persons traveling to settings with no pediatric PCV13 program (use VIEW-hubexternal icon to see which countries use PCV13)
  • Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with increasing age and is higher among persons with chronic heart, lung, or liver disease, diabetes, or alcoholism, and those who smoke cigarettes or who have more than one chronic medical condition. While indirect effects from pediatric PCV13 use were documented for these groups of adults and were comparable to those observed among healthy adults, the residual PCV13-type disease burden remains higher in these groups. Providers/practices caring for patients with these medical conditions may consider offering PCV13 to such patients who are aged ≥65 years and who have not previously received PCV13.

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[5 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 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 adults receive 1 dose of PCV13, if indicated and if they have not received PCV13 previously (including childhood series). In addition, adults age 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant can choose to receive PCV13 based on shared clinical decision-making. However, if an adult received a dose of PCV13 prior to turning 65 years of age (due to a medical indication), they should not receive a dose of PCV13 when they turn 65.

Page last reviewed: November 21, 2019