ACIP Changes Pneumococcal Vaccine Interval in Low-Risk Elderly

Diana Phillips

September 04, 2015

The Advisory Committee on Immunization Practices (ACIP) has revised its interval recommendations for the pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13) in older healthy adults.

Specifically, immunocompetent adults older than 65 years who have not previously been vaccinated with pneumococcal vaccine should receive a dose of PCV13, followed at least 1 year later by a dose of PPSV23, according to the updated guidelines, published in the September 4 issue of the Morbidity and Mortality Weekly Report. If PPSV23 is given earlier than the recommended interval, the dose need not be repeated, the guidelines specify.

"No clinical studies evaluating efficacy of the two vaccines given in series are available. Therefore, current recommendations are based on best available evidence from immunogenicity studies," the authors write.

In its previous guidelines published in 2014, the ACIP recommended routine use of a dose of PCV13 followed 6 to 12 months later by a dose of PPSV23. The change harmonizes the vaccine interval in this patient population with that recommended for immunocompetent adults older than 65 years who already received a dose of PPSV23. For adults in the latter group, the guidelines are unchanged: They should receive a dose of PCV13 at least 1 year after receiving the PPSV23, according to the report.

The revision is supported by studies of PCV–PPSV23 sequence among immunocompetent adults suggesting that shorter between-dose intervals may be associated with increased local reactogenicity when compared with longer intervals, whereas intervals of at least 1 year may lead to an improved immune response against serotypes in both vaccines compared with a single dose of either, the authors write.

The vaccine interval recommendations for other patient populations remain unchanged from the existing guidelines. In particular, a dose of PPSV23 should be given at least 8 weeks after a dose of PCV13 in children and adults at high risk for pneumococcal disease, including those with an immunocompromising condition, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implant.

"The currently recommended 8-week interval minimizes the risk window for invasive pneumococcal disease caused by serotypes unique to PPSV23 in these highly vulnerable groups," the authors write.

Children with an immunocompromising condition or functional or anatomic asplenia should receive a second dose of PPSV23 5 years after the first PPSV23, according to the guidelines.

The ACIP voted to change the recommended interval on June 25, 2015.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2015;64:944-947. Full text

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