Pneumococcal Vaccination in RA — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyPneumococcal Vaccination in RASCE Rheumatology

A 60-year-old man with rheumatoid arthritis is taking methotrexate and adalimumab. He has not previously received pneumococcal vaccination and has no asplenia, splenic dysfunction, complement disorder, haematological malignancy, bone-marrow transplant or other cause of severe immunosuppression. According to current UK guidance, which is the most appropriate pneumococcal vaccination approach?

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Correct answer: D — Give one dose of PCV20; if locally held PPV23 stock is being used, one dose of PPV23 is an acceptable alternative

He is eligible for pneumococcal vaccination because immunosuppression due to treatment is a clinical-risk indication. For most clinical-risk patients aged 2 years or over, including most immunosuppressed patients, current UK guidance recommends a single pneumococcal dose: PCV20 is the replacement programme vaccine, while PPV23 remains acceptable where locally held stock is still being used. PCV13 alone is not the adult clinical-risk schedule. Vaccination should not be deferred because he receives adalimumab; pneumococcal vaccines are non-live. Two PCV20 doses at least 4 weeks apart are reserved for severe immunosuppression, such as haematological malignancy or post-transplant states, which are excluded in the stem. Although BSR advises considering a short methotrexate interruption after influenza or COVID-19 vaccination, this should not be extrapolated routinely to pneumococcal vaccination.

Reference: UK Health Security Agency. Pneumococcal vaccination for older adults and for individuals in a clinical risk group: information for healthcare practitioners, sections "Immunosuppression" and "Schedules", updated 13 April 2026. https://www.gov.uk/government/publications/pneumococcal-vaccination-for-older-adults-and-for-individuals-in-a-clinical-risk-group-information-for-healthcare-practitioners/pneumococcal-vaccination-for-older-adults-and-for-individuals-in-a-clinical-risk-group-information-for-healthcare-practitioners