肺炎球菌ワクチン（PCV13）

乳幼児、65歳以上の成人、免疫不全者。

Pregnancy: Safe if indicated.

Pneumococcal vaccines (PCV, PPSV23) are inactivated and considered safe during pregnancy when indicated.

• Not routinely recommended during pregnancy for healthy women.

• Indicated for pregnant women with high-risk conditions (asplenia, immunodeficiency, chronic lung/heart/liver disease).

• PPSV23 has more post-marketing safety data in pregnancy than PCV.

• Neonatal pneumococcal disease is rare — maternal vaccination primarily benefits the mother.

Breastfeeding: Safe — no restrictions.

Pneumococcal vaccines are inactivated and safe during breastfeeding. No modification to breastfeeding schedule required.

Pediatric use:

• PCV13/PCV15: routine infant immunization. Schedule: 2, 4, 6 months + booster at 12–15 months (3+1) or 2, 4 months + 12 months (2+1 in some countries).

• PCV20 (Prevnar 20): approved from 6 weeks of age (US) — may simplify schedule.

• PPSV23: not recommended <2 years (poor response to polysaccharide antigens). Used from 2 years for high-risk children after PCV series.

• High-risk children (asplenia, immunodeficiency, cochlear implants): PCV + PPSV23 sequential regimen.

• Pneumococcal conjugate vaccines have dramatically reduced invasive pneumococcal disease in children worldwide.

Geriatric use: Routinely recommended for ≥65 years.

• All adults ≥65 years should receive pneumococcal vaccination (WHO, CDC/ACIP).

• Simplified approach (US/ACIP 2023): PCV20 (Prevnar 20) — single dose.

• Alternative: PCV15 (Vaxneuvance) followed by PPSV23 (Pneumovax) ≥8 weeks to 1 year later.

• Immune response may be reduced in immunocompromised elderly, but clinical benefit remains significant.

• Revaccination with PPSV23: one additional dose after 5 years for high-risk individuals who received PPSV23 before age 65.