Pneumococcal disease in adults: Risk levels and vaccine recommendations

There are currently two anti-pneumococcal vaccines available for use in adults: the classical 23-valent polysaccharide pneumococcal vaccine (PPV23) and the new 13-valent pneumococcal conjugate vaccine (PCV13). The main advantage of the PCV13 is the potentially better immunogenicity, with its major disadvantages being the higher cost and the lower serotypecoverage than the PPV23. The currently available scientific evidence supports the following basic recommendations: (i) among adults with greatest risk (basically asplenia and immunocompromised), a dual vaccination (PCV13 + PPV23) is recommended; (ii) among adults with increased risk (basically persons > 65 years-old and patients 15-64 years with chronic pulmonary or heart disease, diabetes and/or alcoholism), a single vaccination with PPV23 is recommended