Pneumococcal Vaccination

Describe the PCV15 vaccine.

-Pneumococcal conjugate vaccine 15-valent

-Vaxneuvance (Merck)

-Indicated for immunization of children ages 6 months to 17 years.

-Routine schedule: 2, 4, 6, 12 to 15 months

-Dose and route: 0.5 mL IM

Describe the PPSV23 vaccine.

-Pneumococcal Polysaccharide Vaccine 23-valent (PPSV23)

-Pneumovax 23 (Merck)

-More efficacious against bacteremia than pneumonia

-Not adequately effective in children <2 years

-Dose and route: 0.5 mL IM (or SC)

Describe the PCV21 vaccine.

-Pneumococcal Conjugate Vaccine 21-valent

-CAPVAXIVE (Merck)

-Safety of PCV21 was assessed in participants aged >/= 19 years.

-Dose and route: 0.5 mL IM

Describe the PCV20 vaccine.

-Pneumococcal Conjugate Vaccine 20-valent

-Prevnar 20 (Wyeth)

-Safety of PCV20 was assessed in immunocompetent adults aged >/= 18 years.

-Dose and route: 0.5 mL IM

-Can be used in adults AND children

What is the minimum age for pneumococcal vaccination with PCV?

6 weeks

What is the minimum age for PPSV23?

2 years

Which vaccines are used for routine pneumococcal vaccination in children?

PCV15 or PCV20

What is the standard dosing schedule for PCV15 or PCV20?

4-dose serious at 2, 4, 6, and 12-15 months

When is PPSV23 used in children?

special situations (high-risk conditions)

In high-risk children needing both PCV and PPSV23, which is given first?

PCV first

Can PCV and PPSV23 be given during the same visit?

no

For children without risk conditions, when is PCV20 NOT indicated?

if they have received 4 doses of PCV13 or PCV15 or another age appropriate PCV series

Which vaccines can be used in children when PCV is indicated?

PCV15 or PCV20

For pneumococcal vaccination, who should receive a vaccination?

-adults 50 years and older

-adults 19 to 49 years with certain underlying medical conditions or other risk factors

Which noncompromising conditions are an indication for the pneumococcal vaccination?

-alcoholism

-cerebrospinal fluid leak

-chronic heart/liver/lung disease

-cigarette smoking

-cochlear implant

-CSF leak

-diabetes

-HIV infection

Which immunocompromising conditions are an indication for the pneumococcal vaccination?

-chronic renal failure

-congenital or acquired asplenia

-congenital or acquired immunodeficiencies

-generalized malignancy

-Hodgkin disease

-Iatrogenic immunosuppression

-leukemia

-lymphoma

-multiple myeloma

-nephrotic syndrome

-sickle cell disease or other hemoglobinopathies

-solid organ transplants

For adults ≥50 years with no prior pneumococcal vaccines, what are the options?

Option A: PCV20 (or PCV21) alone

Option B: PCV15 → then PPSV23 (≥1 year later)

Prior PPSV23 only → what next?

Wait ≥1 year → give PCV20 (or PCV21)

Prior PPSV23 only → alternative option?

Wait ≥1 year → give PCV15

Prior PCV13 only → what next?

Wait ≥1 year → give PCV20 (or PCV21)

Prior PCV13 + PPSV23 (<65 years) → what next?

Wait ≥5 years → give PCV20 (or PCV21)

For adults 19-49 with chronic conditions, what are the main vaccine options?

Option A: PCV20 (or PCV21) alone

Option B: PCV15 → PPSV23 (≥1 year later)

For adults 19-49 with chronic conditions, no prior pneumococcal vaccines → what do you give?

PCV20 (preferred)

OR PCV15 → PPSV23 (≥1 year later)

For adults 19–49 with chronic conditions, prior PPSV23 only → what next?

Wait ≥1 year → PCV20 (or PCV21)

For adults 19-49 with chronic conditions, prior PPSV23 only → alternative option?

Wait ≥1 year → PCV15

For adults 19–49 with chronic conditions, prior PCV13 only → what next?

Wait ≥1 year → PCV20 (or PCV21)

For adults 19–49 with chronic conditions, prior PCV13 + PPSV23 → what do you do?

No vaccines recommended at this time; start thinking about it again at 50 years old.

For adults 19-49 with immunocompromising conditions, what are the options?

Option A: PCV20 (or PCV21) alone

Option B: PCV15 → PPSV23 (≥8 weeks later ⚠️)

For adults 19-49 with immunocompromising conditions, no prior vaccines → what do you give?

PCV20 (preferred)

OR PCV15 → PPSV23 (≥8 weeks later)

For adults 19–49 with immunocompromising conditions, prior PPSV23 only → what next?

Wait ≥1 year → PCV20 (or PCV21)

For adults 19–49 with immunocompromising conditions, alternative after PPSV23 only?

Wait ≥1 year → PCV15

For adults 19–49 with immunocompromising conditions, prior PCV13 only → what next?

Wait ≥1 year → PCV20 (or PCV21)

For adults 19–49 with immunocompromising conditions, prior PCV13 + 1 PPSV23 → what next?

Wait ≥5 years → PCV20 (or PCV21)

For adults 19–49 with immunocompromising conditions, prior PCV13 + 2 PPSV23 → what now?

No vaccines at this time; vaccination should be revisited at 50 years old.

For adults >/= 65 years old who have already completed PCV13 at any age and PPSV23 at >/= 65, should they also receive PCV20 or PCV21?

This is a shared decision making instance. If the patient chooses to do this, they can wait >/= 5 years and then receive PCV 20 or PCV 21