ACIP revises recommendations on pneumococcal vaccine intervals for older adults

The Advisory Committee on Immunization Practices (ACIP) has revised its recommendations for the appropriate interval between pneumococcal vaccines in adults age 65 and older.

The 2 pneumococcal vaccines currently licensed in the U.S. are the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Previously, the ACIP had recommended an interval of 6 to 12 months for the PCV13-PPSV23 sequence in immunocompetent adults 65 years or age and older. After review of the evidence, the ACIP now recommends the following in immunocompetent adults in this age group who have not previously received pneumococcal vaccine:

• A dose of PPSV23 should be given at least 1 year after a dose of PCV13.
• The 2 vaccines should not be administered together.
• If a dose of PPSV23 is given inadvertently before the recommended interval has passed, it does not need to be repeated.

The changes were based on research showing that shorter intervals between doses may be associated with increased local reactogenicity versus longer intervals and that longer intervals between doses of either vaccine may yield an improved immune response against serotypes versus a single dose. In addition, the ACIP noted, the changes make the recommended interval sequence the same in this age group regardless of which vaccine is given first, since the recommendations state that adults who already received PPSV23 when they were 65 years of age and older should receive a dose of PCV13 at least 1 year later. Patients who received a dose of PPSV23 before age 65 years should receive PCV13 at age 65 years or older, followed by PPSV23 at least 1 year later and at least 5 years after the most recent PPSV23 dose.

The ACIP's statement was published Sept. 4 in MMWR.