Patients aged 19 years or older who have functional or anatomic asplenia, immunocompromising conditions, congenital or acquired immunodeficiency, human immunodeficiency virus infection, chronic renal failure or nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, diseases requiring treatment with immunosuppressive drugs such as long-term corticosteroids or radiotherapy, solid organ transplantation, multiple myeloma, cerebrospinal fluid leaks, or cochlear implants are candidates for both PPSV23 and PCV13. Although the US Food and Drug Administration approved PCV13 for children aged 6 weeks through 5 years in 2010
3 and for adults aged 50 years or older in 2011,
4 the ACIP—after review of the research—believed the evidence supported the use of PCV13 for individuals listed above aged 19 years or older.
There are 2 categories of patients: (1) patients who have not received PPSV23 and (2) patients who have received PPSV23. For those who have not previously received PPSV23, PCV13 should be given first, at least 8 weeks before PPSV23 is administered. Individuals who have previously received PPSV23 should be given PCV13 one year after last dose of PPSV23. For persons with functional or anatomic asplenia and for persons with immunocompromising conditions, a second dose of PPSV23 is recommended 1 or more years after PCV13 and 5 or more years after the first dose of PPSV23.