Patient/caregiver was instructed regarding indications to receive PPSV23 pneumococcal vaccination as follows:

1. PPSV23 vaccine administered into the muscle or beneath the skin, is usually recommended for adults, 65 years and older. offers protection against 23 of the approximately 90 types of pneumococcal bacteria causing the most serious types of pneumococcal illnesses in older adults, such as, pneumonia, meningitis, and bacteremia.
2. Adult individuals, 19-64 years of age with poor immune status and especially those with no history of receiving a pneumococcal vaccine in the past or those with unknown vaccination history could receive PCV13 vaccine. Poor immunity status could include individuals with HIV, organ transplants, chronic steroid use, cancer diagnoses, bone marrow suppression, and absence of spleen. These individuals are recommended to receive one dose of PCV13 vaccine. This should be followed by one dose of PPSV23 vaccine at least 8 weeks later to receiving PCV13 and a second dose of PPSV23 vaccine at least 5 years later to receiving the first dose of the same.
3. Adult individuals 19-64 years of age with history of cerebrospinal fluid (CSF) leak and especially those with no history of receiving a pneumococcal vaccine in the past or those with unknown vaccination history could receive one dose of PCV13 vaccine. CSF is a clear & colorless fluid surrounding the brain & spinal cord and offers protection to them from any mechanical damage, by acting as a shock absorber. Risk for CSF leak could be high in some individuals secondary to factors such as, severe head injury, brain tumor, receiving epidural anesthesia, or undergoing any brain surgery. Leakage of this fluid in individuals with above mentioned health conditions can increase the risk of them developing meningitis due to pneumococcal infection. Receiving a dose of PCV13 vaccine by these individuals can help reduce the risk for meningitis. This should be followed by one dose of PPSV23 vaccine at least 8 weeks later to receiving PCV13 and a second dose of PPSV23 vaccine at least 5 years later to receiving the first dose of the same.
4. Adult individuals 19-64 years of age with history of poor hearing & considering a cochlear implant to assist with improved hearing function and especially those with no history of receiving a pneumococcal vaccine in the past or those with unknown vaccination history are recommended to receive one dose of PCV13 vaccine. Cochlear implant surgery carries a remote risk for leakage of CSF fluid, contributing to development of meningitis infection. Receiving a dose of PCV13 vaccine can help reduce or prevent risk for meningitis in these individuals. This should be followed by one dose of PPSV23 vaccine at least 8 weeks later to receiving PCV13 and a second dose of PPSV23 vaccine at least 5 years later to receiving the first dose of the same.
5. Adults 19-64 years of age with chronic health conditions causing severe debility, such as, CHF, asthma, COPD, cirrhosis of liver, and renal failure can have very poor immune status. Consequently, these individuals could be at risk for infection with pneumococcal bacteria resulting in complications of pneumonia and sepsis. Receiving PPSV23 vaccine by these individuals can help reduce the risk for pneumococcal infection, sepsis, and pneumonia. These individuals could receive one dose of PPSV23 vaccine between 19-64 years of age, followed by a second dose of PPSV23 at 65 years or older. The administration of second dose of PPSV23 must be at least 5 years later to the administration of the first.
6. Cigarette smoking is a serious risk factor for infection with pneumococcal pneumonia. History of COPD in smokers can increase this risk further. Smoking disrupts the lining of the respiratory passages in the throat and lungs, which results in increased risk for contacting infections caused by pneumococcal bacteria. This leads to increased chances for presentation with pneumonia, sepsis, and meningitis in these individuals. Receiving PPSV23 vaccine by all smoking adults, 19 years or older, can help substantially reduce the risk for pneumonia & sepsis in these individuals. These individuals could receive a second dose of PPSV23 at 65 years or older. The administration of second dose of PPSV23 must be at least 5 years later to the administration of the first.
7. All adults 65 years and above, especially with no history of receiving a pneumococcal vaccine in the past or those with unknown vaccination history are recommended to receive one dose of PCV13 vaccine before receiving the starting dose of PPSV23 vaccine. A dose of PCV13 vaccine, followed at least one year later by a dose of PPSV23 vaccine is recommended for all such adults 65 years and above. PCV13 and PPSV23 vaccines should never be co-administered. Once a dose of PPSV23 is received by these individuals, usually no further doses need be considered.