Lucio Volino, PharmD, FAPhA, RUCIF, NCNTT

Panelists discuss how pharmacists should ensure patients receive at least one conjugated pneumococcal vaccine (PCV-15, PCV-20, or PCV-21) as the foundation of protection, with subsequent vaccine sequencing depending on which initial vaccine was given—where PCV-15 recipients should receive PPSV-23 one year later for additional serotype coverage, patients with prior PCV-13 need PCV-20 or PCV-21 after a one-year interval, and immunocompromised patients or those with cochlear implants/CSF leaks can have shortened intervals of 8 weeks between doses due to their higher risk for serious disease.

Panelists discuss how ACIP's decision to lower the pneumococcal conjugate vaccine age recommendation from 65 to 50 years was supported by evidence showing that 33-54% of adults aged 50-64 already had risk factors for vaccination, nearly 90% of those hospitalized with pneumococcal disease in this age group had at least one risk condition, mortality rates between the 50-64 and 65+ age groups had become comparable, and age-based recommendations are easier to implement than risk-based approaches, though vaccination coverage remains low at less than 40% among eligible adults with risk factors.

Panelists discuss how pneumococcal vaccines differ between conjugated vaccines (PCV-15, PCV-20, PCV-21) and polysaccharide vaccines (PPSV-23) in terms of immune response mechanisms and serotype coverage, with current CDC recommendations now including all adults aged 50 and older for vaccination while maintaining risk-based recommendations for adults 19-49 years with underlying conditions such as immunocompromising diseases, chronic heart/lung/liver disease, diabetes, alcohol use disorder, and cigarette smoking.

Panelists discuss how pneumococcal disease affects adults through both non-invasive infections like pneumonia and invasive pneumococcal disease (IPD), with current U.S. data showing over 33,000 IPD cases and 3,600 deaths in 2023, particularly impacting adults aged 50 and older who face increased risk due to age-related immunosenescence and underlying medical conditions such as compromised immune systems, chronic diseases, and social factors like crowded living environments.