How often should Prevenar 13 be given over 70? A look at pneumococcal vaccine recommendations

According to the CDC, pneumococcal disease is a significant risk for older adults, with half of all deaths occurring in people over 65. Understanding the correct vaccination schedule, including how often should Prevenar 13 be given over 70, is a crucial step in proactive senior health management.

Quick Summary

The standard recommendation is a single dose of Prevenar 13 (PCV13) for eligible adults over 70, often followed by a different pneumococcal vaccine to complete the series. Current guidelines favor newer vaccines like PCV20 or PCV15 for those starting their immunization series.

Key Points

• Single Dose, Not Repeated: Prevenar 13 (PCV13) is typically given once to an adult over 70 and not repeated. The focus is on completing a series with other vaccines.

• Newer Vaccines Preferred: Current guidelines often recommend a single dose of PCV20 or PCV15 for older adults who have not been previously vaccinated.

• PCV13 Followed by PPSV23: For those who need or have already received PCV13, a dose of PPSV23 is required at least one year later to complete the series.

• Shared Decision-Making: For certain immunocompetent adults over 65, the decision to use PCV13 is made in consultation with a doctor, especially if they have specific risk factors.

• Immunocompromised Considerations: For high-risk, immunocompromised patients, the interval between PCV13 and PPSV23 can be shorter (8 weeks), but PCV13 is usually a single dose.

• Risk Reduction, Not Eradication: While vaccination dramatically reduces risk, pneumococcal disease remains a serious threat to older adults, making up-to-date immunization crucial.

Understanding the Evolution of Pneumococcal Vaccine Recommendations

For older adults, staying up-to-date with pneumococcal vaccines is vital for preventing serious illnesses like pneumonia, meningitis, and bloodstream infections. However, the guidelines for vaccination have evolved, moving away from routine use of Prevenar 13 (PCV13) for all seniors and toward a more tailored approach. Initially, the Advisory Committee on Immunization Practices (ACIP) recommended a series involving both PCV13 and PPSV23 for adults aged 65 and older. This was based on the vaccine's individual efficacy. However, widespread pediatric vaccination significantly reduced the prevalence of PCV13-type disease in the population, a phenomenon known as herd immunity. As a result, the strategy has changed.

The Current Vaccine Landscape for Adults Over 65

In 2019, the ACIP updated its guidance for immunocompetent adults aged 65 or older. Instead of a routine PCV13 recommendation, they advised using PCV13 based on shared clinical decision-making with a healthcare provider.

More recent recommendations further simplify the process by favoring newer, more comprehensive conjugate vaccines.

Updated Recommendations for Pneumococcal-Vaccine-Naive Adults (No Prior PCV or PPSV23)

For older adults with no prior pneumococcal vaccination, the CDC recommends one of two pathways:

• Receive one dose of PCV20. This completes the pneumococcal vaccination series and no further doses are needed.
• Receive one dose of PCV15, followed by a dose of PPSV23 at least one year later. For individuals with an immunocompromising condition, this interval can be shortened to 8 weeks.

What if You've Already Had a Pneumococcal Vaccine?

Your specific schedule depends on your vaccination history:

• If you previously received PPSV23 only, you should receive a dose of either PCV20 or PCV15 at least one year after your PPSV23 dose. If you receive PCV15, no further PPSV23 dose is needed. If you received your PPSV23 dose before age 65, an additional dose may be needed at age 65 or older, with specific intervals.
• If you previously received PCV13 only, it is now recommended to complete the series with a dose of PPSV23, which should be given at least one year after the PCV13 dose. An alternative is to receive a single dose of PCV20 if PPSV23 is unavailable, which would complete the series.

The Role of Shared Clinical Decision-Making

While PCV13 is not routinely recommended for all older adults, it can still be a consideration in some cases. When engaging in a discussion with your doctor, factors to consider include:

• Risk of exposure: Residing in a nursing home or traveling to regions with low pediatric vaccination rates may increase exposure to PCV13 serotypes.
• Underlying medical conditions: While herd immunity has lowered risk, conditions like chronic heart or lung disease, liver disease, or diabetes still increase individual susceptibility to pneumococcal disease.

Pneumococcal Vaccine Series Comparison Table

Here is a quick reference for the modern vaccination pathways for adults 65+.

Scenario	Recommendation	Additional Details
Never vaccinated before	One dose of PCV20	Series is complete.
Never vaccinated before	One dose of PCV15, followed by one dose of PPSV23	PPSV23 given 1 year after PCV15 (8 weeks for immunocompromised).
Previously received PPSV23 only	One dose of PCV20 or PCV15	Given at least 1 year after PPSV23. No further doses needed after PCV20. If PCV15 given, series is complete.
Previously received PCV13 only	One dose of PPSV23	Given at least 1 year after PCV13. Series is complete.

Conclusion

The question of how often should Prevenar 13 be given over 70 has a changing answer, as PCV13 is no longer the primary vaccine for initial immunization in this age group. Most older adults now receive a single dose of a newer conjugate vaccine like PCV20, or a series involving PCV15 and PPSV23. For those who previously received PCV13, a follow-up dose of PPSV23 is typically needed. These recommendations are designed to provide the broadest possible protection while reflecting the current epidemiology of pneumococcal disease.

Always consult with a healthcare professional to determine the most appropriate vaccine schedule for your individual health needs and history. For the most recent guidelines, it's best to consult authoritative sources like the Centers for Disease Control and Prevention at www.cdc.gov/vaccines/vpd/pneumo/.

Frequently Asked Questions

How often should Prevenar 13 be given over 70 if I've never been vaccinated?

If you are over 70 and have never received a pneumococcal vaccine, the current recommendation is likely for a newer vaccine, such as a single dose of PCV20, not Prevenar 13. Speak with your doctor about the best course of action for your situation.

If I received Prevenar 13 before age 65, do I need it again over 70?

No, you do not need another dose of Prevenar 13. Your doctor will likely recommend a follow-up dose of PPSV23 if you haven't received it yet, based on the recommended intervals.

Why are newer vaccines like PCV20 now recommended instead of Prevenar 13?

Newer vaccines like PCV20 cover more serotypes of pneumococcal bacteria than Prevenar 13 (which covers 13). This provides broader protection, and widespread pediatric vaccination has made the original PCV13-type strains less common in the general population.

What is the interval between Prevenar 13 and PPSV23 for someone over 70?

For immunocompetent adults over 65 who receive PCV13 (or received it earlier), the follow-up dose of PPSV23 should be given at least one year later. For immunocompromised individuals, this interval is shorter, at a minimum of 8 weeks.

Can I get Prevenar 13 and the flu shot at the same time?

Yes, pneumococcal vaccines and flu vaccines can generally be administered at the same visit. Co-administration is considered safe and effective.

Is Prevenar 13 still recommended for any adults over 70?

While not routinely recommended for all, Prevenar 13 might still be part of the series for adults over 70 with specific high-risk conditions or a particular exposure risk, based on a discussion with their healthcare provider.

What if I can't remember my vaccination history?

If your vaccination history is unknown, consult your healthcare provider. They can help determine the appropriate vaccination series based on the current guidelines, likely opting for a newer vaccine like PCV20 to ensure maximum protection.