Pneumococcal Vaccine Interval Prolonged for Older Adults

The Advisory Committee on Immunization Practices (ACIP) recently updated the recommended interval between the 13-valeant pneumococcal conjugate vaccine (PCV13) and the 23-valeant pneumococcal polysaccharide vaccine (PPSV23) in low-risk elderly patients.

For immunocompetent adults ages 65 or older who have not previously received a pneumococcal vaccine, the ACIP now advises that a dose of PPSV23 (Pneumovax) should be given ≥1 year following a dose of PCV13 (Prevnar 13). This is an update from the ACIP’s August 2014 guideline, in which it recommended that a PPSV23 dose should be given in this population 6 to 12 months following a PCV13 dose.

Recognizing that this former guidance created implementation challenges for this patient group, the ACIP assessed whether the best available evidence supports lengthening the recommended interval for the immunization sequence.

Although no clinical trials have evaluated the efficacy of the 2 vaccines given in a series, immunogenicity studies in immunocompetent adults suggest that shorter intervals (eg, 8 weeks) may be associated with increased local reactogenicity when compared with longer intervals, and longer intervals (eg, ≥1 year) may lead to an improved immune response against serotypes in both vaccines compared with a single dose of either one.

Other factors that supported the ACIP’s latest recommendation are the risk window for protection against disease caused by serotypes unique to PPSV23, the typical 1-year timing for the next visit to the vaccination provider, and the revised US Centers for Medicare and Medicaid Services (CMS) regulations allowing for Medicare coverage of a different, second pneumococcal vaccine 1 year after the first vaccine is given.

Meanwhile, the recommended intervals for all other patient age and risk groups remain unchanged. For example, those 65 or older with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants are recommended to receive the PCV13 vaccine first, followed by the PPSV23 vaccine at least 8 weeks later.