Table 8.

Pneumococcal vaccination guidelines in Spain. PPSV23v: 23-valent Pneumococcal polysaccharide vaccine. PCV13v: 13-valent pneumococcal conjugate vaccine, PCV20v: 20-valent pneumococcal conjugate vaccine. HIV: Human Immunodeficiency Virus. CSF fistula: cerebrospinal fluid fistula [151,152].

Population Group	Recommended Pattern	Modifications in Autonomous Regions
Over 65 yrs without risk factors	PPSV23v (1 dose)	PCV20v or PCV13v (1 dose)
Over 18 yrs with chronic pathology: chronic cardiovascular and respiratory disease, severe neurological and neuromuscular disease, chronic liver disease, Diabetes mellitus, celiac disease, institutionalized persons	PPSV23v 1 dose + revaccination each 5 years	PCV20v or PCV13v (1 dose)
Over 18 yrs high risk groups: immunodeficiencies and complement system deficiencies, immunosuppressive treatment, asplenia or severe splenic dysfunction, HIV infection, chronic renal failure and nephrotic syndrome, transplant, CSF fistula, cochlear implant, history of invasive pneumococcal disease, liver cirrhosis and chronic alcoholism, Down syndrome.	PCV13v (1 dose) + PPSV23v (1 dose) (at least 8 weeks)	PCV20v (1 dose) + PPSV23v (1 dose) (at least 8 weeks)