Universal Vaccines
Pneumococcal
Only 20% of high risk adults ages 19 to 49 receive PPSV23 and PCV13. Vaccine rates for those over age 65 are approximately 60%.5 This difference is significant and might stem from confusion among primary care physicians about when pneumococcal vaccination is indicated. Indications for pneumococcal vaccination before age 65 can be confusing. Some details are worth committing to memory but refer to the ACIP guidelines when further clarification is needed.
What to know in clinic:
There are 2 vaccines: Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23)
In their lifetime adults should get 1 dose of PCV13 and 1-3 doses of PPSV23 (depending on circumstances)
NEVER give PCV13 and PPSV23 at the same visit
Usually give PCV13 first (if neither have been given)
Generally PCV13 and PPSV23 should be given 1 year apart (exception: only wait 8 weeks after PCV13 to give PPSV23 if immunocompromised)
The interval between repeat PPSV23 doses is at least 5 years
Specific details for determining how to vaccinate:
Immunocompetent adults > 65
- Never received PCV13 or PPSV23: PCV13 followed by PPSV23 1 year later
- Already received PPSV23 after 65: Wait 1 year and give PCV13
- Already received PCV13 after 65: Wait 1 year and give PPSV23
- Received PCV13 before age 65: Still wait at least 1 year before giving PPSV23
- Received PPSV23 before age 65: Give a second dose 5 years following prior dose of PPSV23
Anatomical/functional asplenia and immunocompromised adults >19
- Ideally: PCV13 followed by PPSV23 in 8 weeks followed by PPSV23 in 5 years. Give third dose of PPSV23 after age 65
- If they received PPSV23 initially they still need PCV13 and repeat PPSV23 but keep in mind timing of when these can be given
Immunocompromised hosts include those with congenital/acquired immunodeficiency, HIV, CKD, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation)
Adults with chronic diseases age 19-64
- Give PPSV23
- At age 65 given PCV13 (at least 1 year after PPSV23 given) followed by PPSV23 (at least 1 year after PCV13 and at least 5 years after last dose of PPSV23)
Chronic disease include those with CHF/cardiomyopathy, COPD, asthma, chronic liver disease/cirrhosis, alcoholism, diabetes mellitus, tobacco abuse