A 60-year-old man with chronic obstructive pulmonary disease (COPD) and a 40-pack-year smoking history is due for pneumococcal vaccination. According to current Indian and international guidelines, which vaccination schedule is recommended for him?
- A PPSV23 (23-valent polysaccharide vaccine) alone, single dose
- B PCV13 alone, single dose
- C PCV13 (13-valent conjugate vaccine) followed by PPSV23 after 8 weeks ✓
- D PPSV23 followed by PCV13 after 1 year
Correct answer: C. PCV13 (13-valent conjugate vaccine) followed by PPSV23 after 8 weeks
Explanation
For immunocompetent adults aged 19-64 with risk factors (COPD, smoking, chronic heart/liver disease), current guidelines recommend PCV13 followed by PPSV23 at least 8 weeks later. The conjugate vaccine induces T-cell-dependent memory and broader serotype coverage, while PPSV23 extends coverage to additional serotypes. Giving PPSV23 first can blunt the response to subsequent PCV13 due to T-cell-independent exhaustion, so PCV13 must precede PPSV23.
Reference: CDC Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.