Jean Covino, DHSc, MPA, PA-C

Jean Covino, DHSc, MPA, PA-C, is a clinical professor and director of didactic education at the Pace University-Lenox Hill Hospital PA Program-NYC in New York, New York.

Jennifer Hofmann, MS, PA-C, is an associate clinical professor at the Pace University-Lenox Hill Hospital PA Program-NYC.

Pneumococcal vaccination is an important part of preventive health care in adults 65 years and older and in some younger adults with certain medical conditions.

is a leading cause of pneumonia, and it is associated with other invasive diseases, including bacteremia, meningitis, and otitis media. Appropriate vaccination of adults effectively reduces invasive pneumococcal disease.

There are 2 types of vaccines: the pneumococcal conjugate vaccine (PCV) and the pneumococcal polysaccharide vaccine (PPSV). The PPSV vaccine contains 23 partially purified pneumococcal capsular polysaccharides serotypes, which are most commonly associated with invasive pneumococcal disease. The PPSV vaccine is recommended for all adults initially at 65 years and older. The PPSV is also indicated for certain adults younger than 65 years chronic medical conditions. Certain patients need both types of pneumococcal vaccines, and in these patients the PCV should generally be administered prior to the PPSV (see

). The PPSV protects 50% to 85% of relatively healthy adults from invasive pneumococcal disease.

The PCV vaccine contains 13 pneumococcal capsular polysaccharides covalently linked to a protein. This formulation increases mucosal immunity, which decreases nasopharyngeal carriage and increases antibody production in infants and young children. Specific indications for adults are based on age and medical indications (see

). In 2014, the Advisory Committee on Immunization Practices (ACIP) recommended the routine use of 13-Valent Pneumococcal Conjugate Vaccine

PCV13) in series with 23-valent pneumococcal polysaccharide vaccine

PPSV23) for all adults aged ≥65 years based on demonstrated PCV13 efficacy and safety against PCV13-type pneumonia among adults aged ≥65 years.

ACIP recognized that there would be a need to reevaluate this recommendation, because it was anticipated that PCV13 use in children would continue to reduce disease burden among adults. Consequently, after having reviewed the evidence accrued during the preceding 3 years, in June 2019, the ACIP voted to remove the recommendation for routine PCV13 use among adults aged ≥65.

Updated Recommendations for the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Among Adults

People treated with immunosuppressive drugs, long-term systemic corticosteroids, and radiation therapy

2nd dose ≥ 5 years after first PPSV23 dose

*Based on shared clinical decision making

If PCV 13 has been given, then given PPSV23 ≥ 1 year after PCV13

If PCV 13 has been given, then given PPSV23 ≥ 1 year after PCV13 and ≥ 5 years after any PPSV23 at age < 65

1 dose ≥ 8 weeks after PCV13 and ≥ 5 years after any PPSV23 at < 65 years

Articles

Pneumococcal vaccination is an important part of preventive health care in adults 65 years and older and in some younger adults with certain medical conditions. 

Jean Covino, DHSc, MPA, PA-C

Articles

What are the New Pneumococcal Vaccination Recommendations for Adults?