CDC Recommendations for Use of Pneumococcal Conjugate Vaccine-13 valent (PCV13) in Adults

David Weber

Streptococcus pneumoniae (pneumococcus) remains a leading cause of serious illness, including bacteremia, meningitis, and pneumonia among adults in the United States.  An estimated 4,000 deaths occur in the United States each year because of S. pneumoniae, primarily among adults. The incidence of invasive pneumococcal disease (IPD) ranges from 3.8 per 100,000 among persons aged 18-34 years to 36.4 per 100,000 persons among those aged >65 years.  For adults aged 18-64 years with hematologic cancer, the IPD in 2010 was 186 per 100,000, and for persons with HIV the rate was 173 per 100,000.  The disease rated for adults in these groups can be more than 20 times those for adults without high-risk medical conditions.

There are currently two vaccines available to prevent IPD and pneumonia in adults: 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck & Co.) and 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13, Pfizer).  Each vaccine is ONLY effective against the serotypes in the vaccine.  Both vaccines are FDA approved for all adults >50 years.  PPSV23 is also FDA approved for high-risk adults aged >18 years. 

• UNC Health Care supports the use of pneumococcal vaccines per CDC/ACIP recommendations.  Current CDC/ACIP recommendations for the use of pneumococcal vaccine are as follows:

• Adults >65 years
  • Pneumococcal vaccine-naïve persons:  Single dose of PPSV23
  • Previous vaccination with PPSV23; revaccination with PPSV23 if patient is now greater >65 years of age, previous PPSV23 dose was before 65 years, and >5 years have elapsed since previous dose of PPSV23. 

• Adults 19-64 years with high-risk conditions (see table)
  • Pneumococcal vaccine-naïve persons:  Adults aged >19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later.  Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk.  Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV dose of persons 19-64 years with functional or anatomic asplenia and for persons with immunocompromising conditions.  Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65, or later if at least 5 years have elapsed since their previous PPSV23 dose. 
  • Previous vaccination with PPSV23:  Adults aged >19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, who have received >1 dose of PPSV23 should be given a PCV13 dose >1 year after the last PPSV23 dose was received.  For those who require additional doses of PPSV23, the first dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23. 

For additional details see the forma CDC/ACIP recommendations at:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm

Source:  CDC.  MMWR 2012;61:816.