Prior to the recent change, ACIP recommended both PCV13 and PPSV23 for those ≥ 65 years. Now, PCV13 is not recommended routinely for immunocompetent adults ≥ 65 years; however, individuals in this age group who have chronic underlying medical conditions may receive PCV13 after consulting with their physician. PPSV23 is still recommended for all adults in this age group. Recommendations for those with immunocompromising conditions are also unchanged.
3 sentences summarize change in vaccine intervals. Another source of confusion is the recommended intervals in administering the 2 vaccines when both are indicated. The current guidance has been simplified and can be summarized in 3 sentences4:
- When both PCV13 and PPSV23 are indicated, give PCV13 before PPSV23.
- For patients ≥ 65 years, separate the vaccines by 12 months or more—regardless of which vaccine is administered first.
- For patients who are 19 to 64 years of age, separate the vaccines by ≥ 8 weeks.
Advice on repeating the PPSV23 vaccine also can be summarized in 3 sentences1:
- When a repeat PPSV23 dose is indicated, give it at least 5 years after the first dose.
- Administer no more than 2 doses before age 65.
- For an individual older than 65, only 1 dose should be administered and it should be done at least 5 years after a previous PPSV23 dose.