Pneumococcal Vaccine Recommendations for Adults
For all adults aged ≥65 years and adults aged 19-64 years with certain underlying medical conditions, either PCV20 alone or PCV15 followed by PPSV23 is recommended if they have not previously received a pneumococcal conjugate vaccine or have unknown vaccination history. 1
General Recommendations by Age Group
Adults ≥65 years:
- For those who have not received any pneumococcal vaccine or have unknown vaccination history: Administer either PCV20 alone or PCV15 followed by PPSV23 at least 1 year later 1, 2
- For those who previously received PPSV23 only: Administer PCV20 or PCV15 at least 1 year after the last PPSV23 dose 1
- For those who previously received PCV13 only: Administer either PCV20 or PPSV23 at least 1 year after the PCV13 dose 1, 2
- For those who completed their recommended vaccine series with both PCV13 and PPSV23: Shared clinical decision-making is recommended regarding use of a supplemental PCV20 dose 1
Adults 19-64 years with certain underlying medical conditions:
- For those with immunocompromising conditions, CSF leaks, or cochlear implants who have not received any pneumococcal vaccine: Administer either PCV20 alone or PCV15 followed by PPSV23 at least 8 weeks later 1
- For those with chronic medical conditions (alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes) who have not received any pneumococcal vaccine: Administer either PCV20 alone or PCV15 followed by PPSV23 at least 1 year later 1, 2
- For those who previously received PPSV23 only: Administer PCV20 or PCV15 at least 1 year after the last PPSV23 dose 1
- For those who previously received PCV13 only: Administer PPSV23 at least 1 year after the PCV13 dose 1, 3
Special Populations
Hematopoietic Stem Cell Transplant Recipients:
- Administer 3 doses of PCV20 or PCV15, 4 weeks apart, starting 3-6 months after transplant 1
- For PCV20 schedule: Administer a fourth PCV20 dose ≥6 months after the third dose or ≥12 months after transplant, whichever is later 1
- For PCV15 schedule: Follow with PPSV23 ≥12 months after transplant if no chronic graft-versus-host disease (GVHD); if chronic GVHD is present, administer a fourth dose of PCV15 instead of PPSV23 1
Important Considerations
- The recommended interval between PCV15 and PPSV23 is at least 8 weeks for immunocompromised adults and at least 1 year for immunocompetent adults 2, 3
- Pneumococcal vaccines should not be administered to individuals with history of severe allergic reaction to any component of the vaccine 4
- Defer vaccination in persons with moderate or severe acute illness 4
- Pneumococcal vaccination does not replace the need for antibiotic prophylaxis in patients who require it 4
- Immunocompromised persons may have diminished immune response to pneumococcal vaccines 4, 5
Recent Updates
- In 2021, the ACIP recommendations were simplified with the introduction of PCV15 and PCV20, moving away from the previous complex recommendations that varied by age and risk groups 3
- The most recent evidence confirms the efficacy of pneumococcal conjugate vaccines in preventing both invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia in adults 5, 6
- The 2023 ACIP guidelines represent the most comprehensive update, incorporating all previous recommendations and providing clear clinical guidance for implementation 1
- The newest pneumococcal conjugate vaccine (PCV21) was introduced in 2024, providing coverage against additional serotypes not included in previous vaccines 7, 8
Common Pitfalls to Avoid
- Failing to wait the appropriate interval between PCV15 and PPSV23 (8 weeks for immunocompromised, 1 year for immunocompetent adults) 2, 3
- Administering pneumococcal vaccines to patients with severe allergic reactions to previous doses or vaccine components 4
- Discontinuing antibiotic prophylaxis after pneumococcal vaccination in patients who require it 4
- Not recognizing that immunocompromised patients may have suboptimal immune responses to vaccination 4, 5