Clinical Practice Guidelines 2019 (ICS/NCCP)

Indian Guidelines on Pneumococcal Vaccination With PCV13 and PPSV23¹

Adults Aged 19 to 64 Years

In immunocompetent patients with chronic conditions,* a single dose of PCV13 followed by PPSV23 ≥8 weeks later is recommended.

• In adults with a history of IPD, those with cochlear implants, CSF leak or impaired splenic function, a single dose of PCV13 followed by PPSV23 ≥8 weeks later is recommended

• In all immunocompromised individuals,^† administering a single dose of PCV13 followed by PPSV23 ≥8 weeks later is recommended

Adults Aged 65 years or Older

Vaccination with PCV13 first, followed by PPSV23, is usually recommended for individuals who have immunocompromising conditions, functional or anatomic asplenia, cochlear implant, CSF leak or history of IPD.
For adults with chronic conditions,* the decision to administer a dose of PCV13 preceding PPSV23 should be taken jointly by the physician and the patient, on a case-to-case basis.

• The Indian guidelines are different from the ACIP guidelines, in terms of recommendation regarding vaccination with PCV13 vaccine

• The ACIP guidelines are based on the fact that in the US, PCV13 is being administered to all children since the year 2010, and therefore, there is herd immunity, which prevents adults from being affected by the 13 serotypes covered in PCV13

•  In India, pneumococcal vaccination in the paediatric immunisation schedule has only been incorporated recently. Thus, the concept of herd immunity is not applicable

Hence, in the current guidelines, for individuals aged 19 to 64 years and with health conditions,*,^† ICS/NCCP recommends vaccination with PCV13 followed by PPSV23.

*Such as chronic heart disease, chronic liver disease, poorly controlled diabetes mellitus, chronic lung disease and in current smokers and those with alcohol abuse.
†such as those with HIV infection, iatrogenic immunosuppression, chronic kidney disease, haematologic malignancy, other solid tumour malignancies with or without metastasis, HSCT and solid-organ transplantation.

CSF, cerebrospinal fluid; HSCT, haematopoietic stem cell transplant; ICS/NCCP, Indian Chest Society/National College of Chest Physicians; IPD, invasive pneumococcal disease; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal plain polysaccharide vaccine.

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