Within the past 5 years, it has been recommended that patients age 19 or older, who have severely compromised immune systems should receive both the PPSV23 and PCV vaccines. Patients that have immune-compromising infections such as HIV; or patients who for one reason or another have had to have their spleen removed are at high risk of contracting any bacterial infection and subsequently are at a significantly higher risk of contracting life-threatening complications to an otherwise treatable disease.

This recommendation was also updated to include those age 65 or over.  In patients who are age 65 or older and are in good health are only recommended to receive the PPSV23 vaccine, and are not given the PCV13 vaccination.  There is little evidence to prove that the addition of the PCV13 vaccine in healthy patients who are 65 and older will provide them with superior immunity when compared to the immunity they receive from the PPSV23 vaccination.  Therefore, based on that information, it is recommended that healthy 65 years of age and older patients should only receive the PPSV23 vaccination.

Both the PPSV23 and the PCV13 vaccines should be given to all patients age 65 and older who have immune compromised diseases such as, but not limited to the following:  CSF leak, cochlear implants, asplenia, sickle cell anemia, blood disorders, immunodeficiency, B or T lymphocyte deficiency, complement deficiency, phagocytic diseases, HIV infection, chronic kidney failure, Nephrotic syndrome, Leukemia, Lymphoma, Hodgkin disease, multiple myeloma, malignancy, immunosuppression as a result from chronic use of glucocorticoids or radiation, and solid organ transplant recipients.

These patients have chronic diseases that have interfered with their bodies natural ability to provide immunity against pathogens that are present in the natural world; therefore, in order to prevent them from contracting a bacterial infection that could result in death in an immunocompromised patient, it is recommended for those age 65 and older to receive both PPSV23 and PCV13 vaccines.  Patients who also are smokers or drink alcohol, or have chronic lung disease, diabetes, or other co-morbidities are also recommended to receive both vaccines.