What are the recommendations for pneumococcal (Pneumonia) vaccine administration, including Prevnar13 (Pneumococcal conjugate vaccine, PCV13) and Pneumovax23 (Pneumococcal polysaccharide vaccine, PPSV23)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 3, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Pneumococcal Vaccine Recommendations for Adults

Based on the most recent 2024 Advisory Committee on Immunization Practices (ACIP) recommendations, pneumococcal vaccination should be administered to all adults aged ≥65 years and adults aged 19-64 years with certain risk conditions, with the newly approved 21-valent pneumococcal conjugate vaccine (PCV21) now included as a recommended option. 1

Current Pneumococcal Vaccines Available

  • Four pneumococcal vaccines are currently licensed for use in adults in the United States 1:
    • 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax23)
    • 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar13)
    • 15-valent pneumococcal conjugate vaccine (PCV15, Vaxneuvance)
    • 20-valent pneumococcal conjugate vaccine (PCV20, Prevnar20)
    • 21-valent pneumococcal conjugate vaccine (PCV21, CAPVAXIVE) - newly approved in 2024 1

General Recommendations by Age and Risk Group

Adults Aged ≥65 Years

  • For adults ≥65 years with no prior pneumococcal vaccination or unknown history:

    • A single dose of PCV21, PCV20, or PCV15 is recommended 1
    • If PCV15 is used, a dose of PPSV23 should follow at least 1 year later 1

  • For adults ≥65 years with prior pneumococcal vaccination:

    • If previously received PPSV23 only: Administer a single dose of PCV21, PCV20, or PCV15 at least 1 year after the last PPSV23 dose 1
    • If previously received PCV13 only: Administer a single dose of PCV21, PCV20, or PPSV23 at least 1 year after the PCV13 dose 1

Adults Aged 19-64 Years with Immunocompromising Conditions

  • For adults with immunocompromising conditions, cerebrospinal fluid (CSF) leaks, or cochlear implants:
    • A single dose of PCV21, PCV20, or PCV15 is recommended 1
    • If PCV15 is used, follow with PPSV23 at least 8 weeks later 1
    • These conditions include 1:
      • Chronic renal failure
      • Nephrotic syndrome
      • Immunodeficiencies
      • HIV infection
      • Leukemia, lymphoma, Hodgkin disease
      • Multiple myeloma
      • Generalized malignancy
      • Iatrogenic immunosuppression
      • Solid organ transplant
      • Congenital or acquired asplenia
      • Sickle cell disease or other hemoglobinopathies

Adults Aged 19-64 Years with Chronic Medical Conditions

  • For adults with chronic medical conditions:
    • A single dose of PCV21, PCV20, or PCV15 is recommended 1
    • If PCV15 is used, follow with PPSV23 at least 1 year later 1
    • These conditions include 1:
      • Alcoholism
      • Chronic heart disease
      • Chronic liver disease
      • Chronic lung disease
      • Cigarette smoking
      • Diabetes mellitus

Specific Vaccination Schedules Based on Prior Vaccination History

For Adults ≥65 Years

  • No prior pneumococcal vaccination:

    • Administer a single dose of PCV21, PCV20, or PCV15 1
    • If PCV15 is used, follow with PPSV23 at least 1 year later 1

  • Prior PPSV23 only:

    • Administer a single dose of PCV21, PCV20, or PCV15 at least 1 year after the last PPSV23 dose 1

  • Prior PCV13 only:

    • Administer a single dose of PCV21, PCV20, or PPSV23 at least 1 year after the PCV13 dose 1

  • Prior PCV13 and PPSV23:

    • Shared clinical decision-making is recommended regarding administration of a single dose of PCV21 or PCV20 at least 5 years after the last pneumococcal vaccine dose 1

For Adults 19-64 Years with Immunocompromising Conditions

  • No prior pneumococcal vaccination:

    • Administer a single dose of PCV21, PCV20, or PCV15 1
    • If PCV15 is used, follow with PPSV23 at least 8 weeks later 1

  • Prior PPSV23 only:

    • Administer a single dose of PCV21, PCV20, or PCV15 at least 1 year after the last PPSV23 dose 1

  • Prior PCV13 only:

    • Administer a single dose of PCV21, PCV20, or PPSV23 1
    • If PCV21 or PCV20 is used, administer at least 1 year after the PCV13 dose 1
    • If PPSV23 is used, administer at least 8 weeks after the PCV13 dose 1

  • Prior PCV13 and 1 dose of PPSV23:

    • A single dose of PCV21 or PCV20, or a second dose of PPSV23 is recommended 1
    • If PCV21 or PCV20 is used, administer at least 5 years after the last pneumococcal vaccine dose 1

Important Considerations and Caveats

  • Timing between vaccines:

    • When administering PCV followed by PPSV23, the recommended interval is at least 8 weeks for immunocompromised adults and at least 1 year for immunocompetent adults 1
    • When administering a PCV after PPSV23, wait at least 1 year between doses 1

  • Evolution of recommendations:

    • In 2019, ACIP removed the routine recommendation for PCV13 for all adults aged ≥65 years, shifting to shared clinical decision-making for those without immunocompromising conditions, CSF leaks, or cochlear implants 1
    • This change was based on the reduced burden of PCV13-type disease due to indirect effects from pediatric PCV13 use 1

  • Contraindications:

    • Pneumococcal vaccines are contraindicated in persons with history of severe allergic reaction to any component of the vaccine 1
    • PCVs are also contraindicated in persons with severe allergic reaction to any diphtheria toxoid-containing vaccine 1

  • Special populations:

    • Adults residing in nursing homes or long-term care facilities and those traveling to settings with no pediatric PCV program might benefit more from PCV vaccination 1

  • Coadministration:

    • PCV13 and PPSV23 should not be coadministered 1
    • PCV20 can be administered concomitantly with influenza vaccine, though systemic reactions may be slightly higher 2

Recent Changes and Updates

  • The 2024 introduction of PCV21 (CAPVAXIVE) adds another option to the pneumococcal vaccine arsenal 1
  • PCV21 contains eight pneumococcal serotypes not included in previously recommended vaccines, but notably does not contain serotype 4, which may be important in certain western U.S. populations 1
  • The 2023 ACIP recommendations simplified the approach by recommending a single dose of conjugate vaccine (PCV15, PCV20) for most adults, with PPSV23 following only in certain circumstances 1

By following these updated recommendations, healthcare providers can optimize protection against pneumococcal disease while minimizing unnecessary vaccinations, ultimately reducing morbidity and mortality from pneumococcal infections in adult populations.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What is the recommended pneumonia vaccination schedule for patients over 50 years old?
What is the recommended schedule for the Prevnar (pneumococcal conjugate vaccine) vaccination?
What is the recommended schedule for a 64-year-old to receive the pneumococcal (pneumonia) vaccine, specifically the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) and pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23)?
What pneumococcal (pneumoconjugate or pneumopolysaccharide) vaccine does a 65-year-old male need?
What is the recommended pneumococcal vaccine (Pneumococcal Conjugate Vaccine (PCV) or Pneumococcal Polysaccharide Vaccine (PPSV)) regimen for adults?
What is the treatment for lithium toxicity?
What type of specialist manages and evaluates Chronic Fatigue Syndrome (CFS)?
What is the recommended treatment protocol for major depressive disorder using trazodone?
What is the immediate treatment for gingivitis (inflammation of the gums) in the Emergency Room (ER)?
What is the recommended dosage and treatment plan for mirtazapine (Remeron) in patients with major depressive disorder?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question