Yes, a second dose of PPSV23 is recommended at age 67
Adults aged ≥65 years who received PPSV23 before age 65 should receive one additional dose of PPSV23 at age ≥65 years, administered at least 5 years after the previous PPSV23 dose 1.
Key Recommendation Details
Since this person received PPSV23 at age 60 (before age 65), they are eligible for a second dose once they reach age 65 or later. At age 67, they are now 7 years past their initial vaccination, which exceeds the minimum 5-year interval requirement.
Timing Requirements
- Minimum interval: ≥5 years after the previous PPSV23 dose
- Age requirement: Must be ≥65 years old at time of second dose
- At age 67, this patient meets both criteria (7 years since first dose, and ≥65 years old)
Important Limitations
No additional doses of PPSV23 should be administered following the dose given at age ≥65 years 1. This second dose at age 67 would complete their PPSV23 vaccination series.
Additional Considerations for Newer Vaccines
The 2024 ACIP guidelines 2 now offer alternative options for adults who received PPSV23 before age 65:
- A single dose of PCV21, PCV20, or PCV15 can be given ≥1 year after the last PPSV23 dose as an alternative approach
- If PCV15 is used, it should be followed by PPSV23 ≥1 year later
- If PCV20 or PCV21 is used alone, no additional PPSV23 is needed
Clinical Decision-Making
For this 67-year-old with only PPSV23 at age 60, you have two evidence-based options:
- Give PPSV23 now (traditional approach, completing the two-dose PPSV23 series)
- Give PCV20 or PCV21 instead (newer approach with broader serotype coverage, no additional doses needed)
The newer conjugate vaccines (PCV20/PCV21) provide coverage for additional serotypes and may offer superior immunogenicity compared to a second PPSV23 dose, though either approach is guideline-concordant 2.
Common Pitfall to Avoid
Do not give more than one dose of PPSV23 after age 65. The maximum lifetime doses of PPSV23 is two total doses, with the second dose only given if the first was administered before age 65 1.