What are the recommended pneumonia vaccines and schedules for different age groups and health conditions?

Pneumococcal Vaccine Recommendations by Age Group and Health Condition

For optimal protection against pneumococcal disease, adults should receive either PCV20 alone or PCV15 followed by PPSV23, with specific schedules varying by age and risk factors. 1

General Recommendations by Age Group

Adults ≥65 years

• Preferred option A: Single dose of PCV20
• Alternative option B: Single dose of PCV15, followed by PPSV23 ≥1 year later

Adults 19-64 years with chronic medical conditions

Conditions include: alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus

• Preferred option A: Single dose of PCV20
• Alternative option B: Single dose of PCV15, followed by PPSV23 ≥1 year later

Adults 19-64 years with immunocompromising conditions

Conditions include: congenital/acquired asplenia, sickle cell disease, chronic renal failure, immunodeficiencies, malignancies, HIV, immunosuppressive therapy, solid organ transplant

• Preferred option A: Single dose of PCV20
• Alternative option B: Single dose of PCV15, followed by PPSV23 ≥8 weeks later

Adults with CSF leak or cochlear implant

• Preferred option A: Single dose of PCV20
• Alternative option B: Single dose of PCV15, followed by PPSV23 ≥8 weeks later

Special Population: Hematopoietic Stem Cell Transplant Recipients

• Preferred option: 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth PCV20 dose ≥6 months after the third dose
• Alternative option: 3 doses of PCV15, 4 weeks apart starting 3-6 months after HSCT, followed by PPSV23 ≥12 months after HSCT (if no chronic GVHD) or a fourth dose of PCV15 (if chronic GVHD present)

Vaccination Schedules for Previously Vaccinated Individuals

Adults ≥65 years with previous pneumococcal vaccination

• If previously received PPSV23 only: Administer PCV20 or PCV15 ≥1 year after last PPSV23 dose
• If previously received PCV13 only: Administer PCV20 ≥1 year after PCV13 or PPSV23 ≥1 year after PCV13
• If previously received both PCV13 and PPSV23: No additional vaccination needed if PPSV23 was given at age ≥65 years

Adults 19-64 years with chronic conditions and previous vaccination

• If previously received PPSV23 only: Administer PCV20 or PCV15 ≥1 year after last PPSV23 dose
• If previously received PCV13 only: Administer PCV20 ≥1 year after PCV13 or PPSV23 ≥1 year after PCV13
• If previously received both PCV13 and PPSV23: No additional vaccination until age 65

Evolution of Recommendations

The pneumococcal vaccine recommendations have evolved significantly over time:

• Prior to 2019, PCV13 followed by PPSV23 was routinely recommended for all adults ≥65 years 1
• In 2019, ACIP changed to shared clinical decision-making for PCV13 in adults ≥65 years without immunocompromising conditions, CSF leak, or cochlear implant 1
• By 2023, newer conjugate vaccines (PCV15, PCV20) became preferred options for all adults 1

Key Clinical Considerations

• Timing between vaccines: When both PCV and PPSV23 are indicated, the minimum interval depends on risk factors:

  • For immunocompromised adults: ≥8 weeks between PCV15 and PPSV23
  • For adults with chronic conditions: ≥1 year between PCV15 and PPSV23

• Vaccine differences:

  • PCV vaccines (PCV13, PCV15, PCV20) are conjugate vaccines that produce stronger immune responses through T-cell dependent mechanisms 2, 3
  • PPSV23 covers more serotypes but produces a less robust immune response in certain populations 2

• Common pitfalls to avoid:

  1. Administering PPSV23 too soon after PCV15 (reduces immune response)
  2. Missing vaccination opportunities in adults with chronic conditions
  3. Failing to revaccinate HSCT recipients according to the specialized schedule
  4. Not recognizing that adults who received pneumococcal vaccines before age 65 may need additional doses at 65+

Rationale for Current Recommendations

The shift toward PCV20 or PCV15+PPSV23 is based on:

1. Improved efficacy of conjugate vaccines against both invasive pneumococcal disease and pneumonia 3
2. Broader serotype coverage with newer conjugate vaccines
3. Simplification of vaccination schedules with single-dose PCV20 option
4. Persistent pneumococcal disease burden in adults with chronic conditions 4

These recommendations prioritize protection against pneumococcal disease to reduce morbidity and mortality, particularly in vulnerable populations.