Interpretation of response to pneumococcal polysaccharides in patients two years of age and older with possible immunodeficiency

PPV-23: 23-valent pneumococcal polysaccharide vaccine; PCV-13: 13-valent pneumococcal conjugate vaccine; PCV-7: 7-valent pneumococcal conjugate vaccine.
* The number of serotypes to which the patient is expected to have titers ≥1.3 mcg/mL to be considered adequate is determined by age:

• Age 2 to 5 years: 50% or more of serotypes should be ≥1.3 mcg/mL
• Age 5 and older: 70% or more should be ≥1.3 mcg/mL

Note that in patients who only received the conjugate pneumococcal vaccine in the past, titers ≥0.35 mcg/mL are adequate to provide protection against invasive pneumococcal disease. Also, if the patient received PCV-13 in the past, then ONLY consider the serotypes that are unique to PPV-23 (and not in PCV-13): 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, and 33F. If patient received PCV-7, then the following serotypes can also be considered: 1, 3, 5, 6A, 7F, and 19A.
¶ Poor immunologic memory is detected by an initially adequate response to PPV-23, which then becomes inadequate within one year of vaccination.