Patient selection: age >= 65 years
Pneumovax 23 (PPSV23, 23-valent polysaccharide vaccine) is recommended for all adults >= 65 years of age.
Prevnar 13 (PCV13, 13-valent conjugate vaccine) may or may not be indicated, depending on the patient's circumstances. Because PCV13 has been given to children for over a decade, carriage of the covered strains has reduced.
Patients who may still benefit from Prevnar 13 include:
(1) living in or travelling to a region with no or little vaccination of children with Prevnar 13
(2) nursing home or long-term care facility
(3) chronic heart, lung or liver disease, including alcoholism
(4) diabetes
(5) smokers
(6) immunocompromising condition
(7) cerebrospinal fluid leak
(8) cochlear implant
If the patient meets none of these criteria then Prevnar 13 may not be warranted and only Pneumovax 23 is given.
If Prevnar 13 is deemed appropriate then it is given first, with Pneumovax 23 given 1 year later.
