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1-Minute consult

Does my healthy 65-year-old patient still need the 13-valent pneumococcal conjugate vaccine (PCV13)?

Craig D. Nielsen, MD, FACP and Xian Wen Jin, MD, PhD, FACP
Cleveland Clinic Journal of Medicine November 2020, 87 (11) 656-658; DOI: https://doi.org/10.3949/ccjm.87a.20012
Craig D. Nielsen
Department of Internal Medicine, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Governor, Ohio Chapter, American College of Physicians; Deputy Editor, Cleveland Clinic Journal of Medicine
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  • For correspondence: [email protected]
Xian Wen Jin
Department of Internal Medicine and Geriatrics, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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    FIGURE 1

    Incidence of invasive pneumococcal disease among US adults 65 and older by pneumococcal serotype, 1998–2017.

    Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥ 65 years: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019; 68(46):1069–1075. doi:10.15585/mmwr.mm6846a5

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    TABLE 1

    Summary of current recommendations for pneumococcal vaccination

    Patient populationDosing
    ≥ 65 years old1 dose of PPSV23 If PPSV23 was given before age 65, give another dose at least 5 years after previous dose
    ≥ 65 years old, immunocompetent, with chronic heart disease, chronic lung disease, chronic liver disease, diabetes mellitus, alcoholism, or cigarette smokingShared clinical decision-making: can give PCV13 followed by PPSV23 at least 1 year later
    19 through 64 years old, with chronic heart (excluding hypertension), lung, or liver disease, diabetes, alcoholism, or cigarette smoking1 dose of PPSV23
    19 through 64 years old, with cerebrospinal fluid leak or cochlear implants1 dose of PCV13 followed by 1 dose of PPSV23 at least 8 weeks later
    At age 65 or older, give another dose of PPSV23 at least 5 years after PPSV23 (only 1 dose of PPSV23 recommended for ages 65 or older)
    19 years or older, with congenital or acquired immunodeficiency (including B- and T-lymphocyte deficiency, complement deficiencies, phagocytic disorders, HIV infection), chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression (eg, drug or radiation therapy), solid organ transplant, multiple myeloma, or anatomical or functional asplenia, including sickle cell disease and other hemoglobinopathies1 dose of PCV13 followed by 1 dose of PPSV23 at least 8 weeks later, then another PPSV23 dose at least 5 years after previous PPSV23
    At age 65 or older, give 1 dose of PPSV23 at least 5 years after most recent PPSV23 dose (only 1 dose of PPSV23 is recommended for ages 65 or older)
    • PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

    • Based on information in reference 1.

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Cleveland Clinic Journal of Medicine: 87 (11)
Cleveland Clinic Journal of Medicine
Vol. 87, Issue 11
1 Nov 2020
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Does my healthy 65-year-old patient still need the 13-valent pneumococcal conjugate vaccine (PCV13)?
Craig D. Nielsen, Xian Wen Jin
Cleveland Clinic Journal of Medicine Nov 2020, 87 (11) 656-658; DOI: 10.3949/ccjm.87a.20012

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Does my healthy 65-year-old patient still need the 13-valent pneumococcal conjugate vaccine (PCV13)?
Craig D. Nielsen, Xian Wen Jin
Cleveland Clinic Journal of Medicine Nov 2020, 87 (11) 656-658; DOI: 10.3949/ccjm.87a.20012
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