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Adult Pneumococcal Disease Prevention

CE / CME

Elucidating the Rapid Changes in Pneumococcal Disease Prevention in Adults

Pharmacists: 0.50 contact hour (0.05 CEUs)

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: June 09, 2026

Expiration: June 08, 2027

Richard Colgan
Richard Colgan, MD
CME/CE Information

Activity

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Course Completed

Review: Best Practices Based on Patient History

To summarize what we covered earlier, the choice of pneumococcal vaccine depends on 3 factors: the patient’s prior vaccination history, current age, and risk factors for severe disease.

Let’s go through some examples, starting with people who previously received PPSV23 and PCV13 who have risk factors for severe pneumococcal disease.

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Pneumococcal Vaccine Schedule: Age 19-49 Yr With Immunocompromising Condition, Cochlear Implant, or CSF Leak

For adults 19-49 years of age with immunocompromising conditions, cochlear implant, or CSF leak, you should carefully review prior pneumococcal vaccination history before selecting among the recommended vaccine pathways.

If they had previously received PCV13 alone, they should receive the PCV20 or PCV21 vaccine at ≥1 year later.

If they had previously received both PCV13 and PPSV23, they should still receive the PCV20 or PCV21 vaccine, but you should wait longer (≥5 years later).

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Review: Best Practices Based on Patient History

In clinical practice, many chronic conditions can contribute to some degree of immune compromise, which in turn influences the vaccine recommendations.

However, I rely primarily on CDC guidance tables and evidence-based recommendations when determining vaccine schedules. For example, a patient with well-controlled diabetes may differ substantially from a patient with poorly controlled diabetes and recent diabetic ketoacidosis.

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Pneumococcal Vaccine Schedule: Age 19-49 Yr With Chronic Disease

One difference between the recommendations for people with immunocompromise and the recommendations for people with chronic disease is shown in the last row of this table. For people with chronic disease who have already received both PCV13 and PPSV23, no additional vaccination review is needed until they reach 50 years of age.

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Review: Best Practices Based on Patient History

For adults 50 years of age or older, and especially those 65 years of age or older, prior receipt of PPSV23, PCV13, or other lower valency vaccines substantially influences current vaccine recommendations. Shared decision-making may be appropriate in some situations, particularly when considering administration of PCV20 or PCV21 after prior vaccination.

One factor to consider is their age when they received their prior vaccines.

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Pneumococcal Vaccine Schedule: Age ≥50 Yr

For example, if a person received PCV13 and PPSV23 before they were 65 years of age, they should receive PCV20 or PCV21 ≥5 years later.

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Review: Best Practices Based on Patient History

However, if they received PCV13 and PPSV23 after they were 65 years of age, you can consider the PCV20 or PCV21 ≥5 years later using shared decision-making.

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Pneumococcal Vaccine Schedule: Age ≥50 Yr

In summary, CDC guidance includes several newer pneumococcal vaccine options with expanded serotype coverage for adults.

The newer vaccines, PCV20 and PCV21, were developed to provide broader adult-relevant serotype coverage and to address current IPD patterns.

PCV21 includes 8 serotypes not covered by PCV20 and was specifically designed to target serotypes commonly associated with adult disease.

PCV20 offers the advantage of broader clinical familiarity and continuity across pediatric and adult vaccination schedules, whereas PCV21 provides more targeted adult serotype coverage.

Neither vaccine is universally superior, and vaccine selection should be individualized using evidence-based guidance and shared decision-making.

Current CDC and Advisory Committee on Immunization Practices recommendations support use of either PCV20 or PCV21 alone, or PCV15 followed by PPSV23 for eligible adults.17

For adults 65 years of age or older and other high-risk populations, healthcare professionals can consider either PCV20 or PCV21 as appropriate vaccine options depending on the patient’s prior vaccination history and clinical circumstances.

Do you plan to make any changes in your clinical practice based on what you learned in today’s program?

Please take a moment to enter 1 key change you plan to make in your clinical practice based on this education.

Which of the following explains why pneumococcal disease continues to be a substantial burden in US adults?

If following CDC recommendations, what age cutoff should you use for universal/routine pneumococcal vaccination?

If following CDC guidance, what would you recommend for a person previously vaccinated with PCV13?

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