Pneumococcus Vaccine

Streptococcus pneumoniae (pneumococcus) remains a leading infectious cause of serious illness among older adults in the United States, where it results in hospitalization or death for thousands each year. Pneumococcal disease can cause severe infections of the lungs (pneumonia), bloodstream (bacteremia), and lining of the brain and spinal cord (meningitis). Vaccinations are the best way to prevent pneumococcal disease.

There are two vaccines that can prevent pneumococcal disease:

• PCV13 (pneumococcal conjugate vaccine)
• PPSV23 (pneumococcal polysaccharide vaccine)

Pneumococcus Statistics

• In 2013 an estimated 13,500 cases of IPD occurred among adults aged ≥65 years
• Approximately 20%–25% of IPD cases and 10% of community-acquired pneumonia cases in adults aged ≥65 years are caused by PCV13 serotypes and are potentially preventable with the use of PCV13 in this population
• Use of PCV13 since 2010 among children in the United States has reduced pneumococcal infections indirectly among adults. By 2013, the incidence of invasive pneumococcal disease (IPD) caused by serotypes unique to PCV13 among adults aged ≥65 years had declined by approximately 50% compared with 2010, when PCV13 replaced PCV7 in the pediatric immunization schedule.

Recommendations for PCV13 and PPSV23 Use

• Use of PCV13 and PPSV23 Among Adults ≥19 Years. Current AAFP recommendations for routine use of PCV13 in adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants remain unchanged.
• Use of PCV13 Among Adults ≥65 Years. Both PCV13 and PPSV23 should be administered routinely in series to all adults aged ≥65 years.
• Pneumococcal vaccine-naïve persons. Adults aged ≥65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be co-administered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
• Previous vaccination with PPSV23. Adults aged ≥65 years who have previously received ≥1 doses of PPSV23 also should receive a dose of PCV13 if they have not yet received it. A dose of PCV13 should be given ≥1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6–12 months after PCV13 and ≥5 years after the most recent dose of PPSV23 (15).
• Potential Time-Limited Utility of Routine PCV13 Use Among Adults ≥65 Years. The recommendations for routine PCV13 use among adults aged ≥65 years will be reevaluated in 2018 and revised as needed.