Risk vs. Benefit of Pneumococcal Vaccines: Shared Clinical Decision-Making for Patients and Pharmacists

EP: 1.Epidemiology and High-Risk Populations for Pneumococcal Disease

EP: 2.Comparing Pneumococcal Vaccines and CDC Recommendations for Adults

EP: 3.Updated Evidence-Based Recommendations for Pneumococcal Conjugate Vaccines

EP: 4.Pharmacist’s Guide: Choosing the Most Appropriate Pneumococcal Vaccine for Patients

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EP: 5.Risk vs. Benefit of Pneumococcal Vaccines: Shared Clinical Decision-Making for Patients and Pharmacists

EP: 6.Pneumococcal Vaccine Patient Education: What Pharmacists Should Know and Share

Risk vs. Benefit of Pneumococcal Vaccines: Shared Clinical Decision-Making Summary

Managing patients who previously completed pneumococcal series with both PCV-13 and PPSV-23 requires careful consideration of additional vaccination benefits and timing. These patients have adequate serotype coverage, but much of their protection comes from the polysaccharide vaccine, which provides suboptimal immune responses compared to conjugate vaccines. For high-risk patients under 50 years with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants who received PCV-13 plus one PPSV-23 dose, a single dose of PCV-20 or PCV-21 administered at least five years after their last pneumococcal vaccine completes their series. Patients who received PCV-13 plus two PPSV-23 doses can either wait until age 50 to follow age-based recommendations or receive PCV-20/PCV-21 after the five-year interval, with no additional doses needed thereafter.

Age-based recommendations beginning at 50 years create distinct pathways for patients with prior vaccination histories. Individuals who received PCV-13 and PPSV-23 before age 65 should receive PCV-20 or PCV-21 at least five years after their last pneumococcal dose when they reach 50. However, patients who received PPSV-23 at age 65 or later enter a different category requiring shared clinical decision-making rather than automatic vaccination recommendations. This distinction recognizes that vaccination timing relative to age milestones influences risk-benefit calculations and the appropriateness of additional immunization.

Shared clinical decision-making applies specifically to individuals 65 and older who received PCV-13 followed by PPSV-23 at age 65 or later. This individualized approach moves beyond population-based risk targeting to assess personal risk factors, including underlying medical conditions, time since last vaccination, and potential exposure to serotypes covered by PCV-20 and PCV-21. Healthcare providers and patients collaborate to evaluate the risks and benefits of additional vaccination, particularly for those with high-risk conditions who may gain added protection from conjugate vaccines administered at least five years after their previous dose. This patient-centered approach ensures vaccination decisions align with individual circumstances while maintaining appropriate clinical oversight.