Pneumococcal Disease Risk and Vaccination in Cardiac Conditions: Indian Cardiologists' Group Recommendations

The study published in the July 2025 issue of the Indian Journal of Clinical Cardiology, emphasized the importance of pneumococcal vaccination for immunocompetent individuals with cardiac conditions, including those with prior myocardial infarction (MI) or coronary artery disease (CAD), heart failure (HF), chronic hypertension (CH), older adults over 50 with hypertension, and patients with acute coronary syndrome (ACS) and multiple comorbidities.

Pneumococcal diseases (PDs) caused by Streptococcus pneumoniae increase morbidity and mortality in individuals with cardiac conditions. Patients with community-acquired pneumonia or invasive pneumococcal disease face higher risks of myocardial infarction, heart failure, and arrhythmias, including mortality in the long term. Pneumococcal vaccination can be crucial as a preventive measure to reduce the burden of pneumococcal diseases in patients with underlying cardiac conditions, as it is linked to reduced all-cause mortality in adults with cardiovascular disease or very high cardiovascular (CV) risk.

The evidence-based consensus statements on the use of pneumococcal vaccines in individuals with cardiac conditions were developed by a panel of seven cardiologists through a modified Delphi process. Key findings from the consensus statements are:

SI No	Recommendation	Level of Consensus
1	Single-dose PCV13 followed by single-dose PPSV23 (≥8 weeks later) is the recommended vaccination sequence for adults with cardiac conditions.	High (100%)
2	PCV13 vaccination should be administered to adults with cardiac conditions across all risk levels. ●Low, moderate, and high CV risk patients can benefit from PCV13 ●Particularly beneficial for adults >65 years and those with prior cardiac events	High (85.7%)
3	Risk-based pneumococcal vaccination should be followed for adults with cardiac conditions. ●Ages 19-64 years and ≥65 years with cardiac conditions ●History of MI, CAD, or HF ●Immunocompromised adults with cardiac conditions	High (85.7%)
4	Single-dose PCV13 followed by a single dose of PPSV23 (≥8 weeks later) can be considered for elderly individuals (>50 years) with chronic heart conditions.	Moderate (71.4%)
5	Adults with ACS/MI or chronic heart conditions plus multiple comorbidities should receive PCV13 followed by PPSV23. Comorbidities include: ●LV dysfunction, ●T2DM, ●Obesity, ●COPD, ●CKD, or ●Chronic liver disease	High (100%)

Abbreviations: CV, cardiovascular; ACS, acute coronary syndrome; MI, myocardial infarction; CVD, cardiovascular disease; PCV, pneumococcal conjugate vaccine; PPSV, pneumococcal polysaccharide vaccine; 8WL, weeks later; CAD, coronary artery disease; CH, chronic hypertension; LV, left ventricular; T2DM, type 2 diabetes mellitus; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease

The author of the study Dr. JPS Sawhney, MD, DM (Cardiology), FESC, FACC, FRCP, Senior Consultant Cardiologist, Sir Ganga Ram Hospital, Delhi, India, shared his insights on the consensus and the recent introduction of the PCV20 vaccine, "The previous Delphi consensus recommending PCV13 followed by PPSV23 for adults with cardiac conditions was based on the need to broaden serotype coverage and enhance immune response in this high-risk group. With the availability of PCV20, which includes all serotypes in PCV13 plus 7 additional serotypes also covered by PPSV23, a single dose of PCV20 now offers comparable coverage long term protection without the need for sequential vaccination. Clinical trial data also confirms that PCV20 elicits non-inferior immune responses to other available pneumococcal vaccine. Importantly, these trials included adults with stable chronic cardiovascular disease, and the vaccine was well tolerated across age groups. Therefore, in light of this evidence and the simplified schedule, I would recommend a single dose of PCV20 for adults with cardiac conditions. This also aligns with current CDC/ACIP recommendations and improves compliance while maintaining robust serotype coverage."

PCV20, a newer pneumococcal conjugate vaccine recently introduced in India, provides protection against 20 serotypes of S. pneumoniae in a single dose, offering broader coverage and the advantage of simplified administration compared with the two-dose regimen. The latest CDC-ACIP and Indian Consensus Guidelines on Adult Immunisation suggest consideration of a single dose of PCV20 for all adults aged ≥50 years and for adults aged 19–49 years with immunocompromising conditions such as cancer, HIV, and AIRDs, as well as chronic diseases such as diabetes, chronic heart, lung, liver, or kidney disease.2,3

2. EMVAC. (2024). Adult vaccination booklet. EMVAC. https://www.emvac.in/wp-content/uploads/2024/06/Adult-Vaccination-Booklet.pdf

3. Kobayashi, M., Leidner, A. J., Gierke, R., Xing, W., Accorsi, E., Moro, P., Kamboj, M., Kuchel, G. A., Schechter, R., Loehr, J., & Cohen, A. L. (2025, January 9). Expanded recommendations for use of pneumococcal conjugate vaccines among adults aged ≥50 years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR. Morbidity and Mortality Weekly Report, 74(1), 1–8. https://doi.org/10.15585/mmwr.mm7401a1