Cleveland Clinic Journal of MedicineUpdate on Pneumococcal Vaccination in Adults: Simpler is Better

New guidelines aim to streamline pneumococcal vaccination strategies, potentially improving compliance and disease prevention

The Advisory Committee on Immunization Practices (ACIP) has released updated recommendations for pneumococcal vaccination in adults. These new guidelines, published in 2022, aim to simplify the vaccination process while maintaining effective prevention of invasive pneumococcal disease. The recommendations introduce new vaccine options and revised dosing schedules, addressing both average-risk individuals aged 65 and older and high-risk adults aged 19-64.

Key Points:

• Two new pneumococcal conjugate vaccines are now available: 15-valent (PCV15) and 20-valent (PCV20)
• For adults ≥65 years and at-risk adults 19-64 years who have not received a pneumococcal conjugate vaccine:
  • Administer either one dose of PCV20 alone
  • Or give one dose of PCV15 followed by PPSV23 at least one year later
• Adults who previously received PCV13 should follow existing ACIP recommendations for PPSV23
• PCV20 can replace PPSV23 if the latter is unavailable
• Adults who only received PPSV23 previously may get one dose of PCV20 or PCV15 at least one year after their last PPSV23 dose
• For patients with cochlear implants, cerebrospinal fluid leaks, or immunocompromising conditions:
  • Consider an 8-week interval between PCV15 and PPSV23 instead of one year
  • Alternatively, administer a single dose of PCV20
• The incidence of pneumococcal disease has been decreasing since the introduction of pneumococcal conjugate vaccines in children
• PCV15 covers two additional serotypes causing 15% more cases of invasive pneumococcal disease compared to PCV13
• PCV20 covers seven additional serotypes causing 27% more cases than PCV13
• Clinical trials showed no significant adverse events for PCV15 or PCV20
• Common side effects include injection site reactions, fatigue, myalgia, arthralgia, and headache
• The CDC offers a mobile app, PneumoRecs VaxAdvisor, to help providers determine appropriate pneumococcal vaccines for individual patients

HCN Medical Memo
The updated ACIP recommendations for pneumococcal vaccination in adults offer a more straightforward approach to preventing invasive pneumococcal disease. By incorporating new vaccine options and simplified dosing schedules, these guidelines aim to improve vaccination compliance and effectiveness across different patient populations. Familiarize yourself with these changes to optimize pneumococcal disease prevention in your practice.

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