All persons ≥65 years old and those 2-64 years old who are at increased risk of pneumococcal disease should receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23), which contains capsular polysaccharide from the 23 most prevalent serotypes of S. pneumoniae.
- Persons >2 years old with continuing increased risk should be revaccinated every 5 years.
- Persons whose only indication for vaccination is an age of ≥65 years do not need to be revaccinated.
The efficacy of PPSV23 is controversial; it appears to be effective against invasive pneumococcal disease but less effective or ineffective against nonbacteremic pneumococcal pneumonia.
The duration of protection conferred by PPSV23 is ~5 years.
The poor response of infants and young children to pneumococcal polysaccharide vaccines prompted the development of pneumococcal conjugate vaccines. In the United States, the current recommendation is for infants to be routinely vaccinated with the conjugate vaccine PCV13, which contains the 13 serotypes most associated with disease.
- All immunocompromised children and adults should receive PCV13 prior to receiving PPSV23.
- Pneumococcal conjugate vaccines are highly effective at providing protection against vaccine-serotype invasive pneumococcal disease, pneumonia, otitis media, nasopharyngeal colonization, and all-cause mortality.
- In the United States, there has been a >90% reduction in vaccine-serotype invasive pneumococcal disease among the whole population, including indirect protection of unvaccinated adults.
For a more detailed discussion, see Goldblatt D, O'Brien KL: Pneumococcal Infections, Chap. 171, p. 946, in HPIM-19.