Navigate Pneumococcal Vaccines for Adults

Ongoing changes with pneumococcal vaccine recommendations for adults can make your head spin.

Last year, CDC recommended Prevnar 20 (PCV20) or Vaxneuvance (PCV15) over Pneumovax 23 (PPSV23)alone for eligible adults...those 65 and up or 19 to 64 with risk factors (cancer, diabetes, smoking, etc).

Now CDC’s updated immunization schedule clarifies the role of PCV20 to finish an incomplete series...or for adults who’ve had Prevnar 13 (PCV13) plus PPSV23.

But a LOT is left open to clinical judgment and shared decisions.

Start by using CDC’s PneumoRecs VaxAdvisor app or website when a high-risk inpatient needs a pneumococcal vaccine (postsplenectomy, etc)...or if your hospital screens adults before discharge.

Then consider our PRACTICAL recommendations for eligible adults.

No prior pneumococcal vaccines...lean toward PCV20 as simpler than PCV15. Patients getting PCV15 also need PPSV23, usually after 1 year...depending on risks.

Be aware, PCV20 or PCV15 costs about $240/dose...and PPSV23 costs about $120/dose. All are covered by Medicare Part B.

Prior PPSV23 only...consider giving 1 dose of PCV20 after 1 year.

Prior PCV13 only...generally go with PCV20 after at least 1 year to complete the pneumococcal series, instead of PPSV23.

CDC projects that PCV20 may modestly improve outcomes compared to PPSV23...such as reducing cases of pneumonia.

Prior PCV13 plus PPSV23...tailor based on the patient.

For immunocompromised adults with an INCOMPLETE series, give 1 dose of PCV20 at least 5 years after a prior PPSV23 dose to finish the series.

For adults over 65 who’ve COMPLETED their series with PCV13 plus PPSV23, explain that the benefit of adding PCV20 is small. But it’s okay to give PCV20 after 5 years to seniors who want a bit more protection.

Consider a pneumococcal series “done” once an adult has PCV20.

Learn how products stack up in our resource, Comparison of Pneumococcal Vaccines. Access CDC’s Pneumococcal Vaccine Timing for Adults for a flowchart...including for immunocompromised patients.

Key References

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  • Medication pricing by Elsevier, accessed Feb 2023
Hospital Pharmacist's Letter. March 2023, No. 390308

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