Who should receive the Pneumococcal (Pneumonia 23) vaccine?

Pneumococcal Vaccination Recommendations

All adults aged ≥65 years should receive pneumococcal vaccination, with specific recommendations based on vaccination history and risk factors. 1

General Recommendations by Age Group

Adults aged ≥65 years:

• All adults aged ≥65 years should receive a dose of PPSV23 (23-valent pneumococcal polysaccharide vaccine) 1, 2
• Adults who previously received PPSV23 before age 65 should receive one additional dose of PPSV23 at age ≥65 years, at least 5 years after the previous dose 1
• For pneumococcal vaccine-naïve adults ≥65 years, either PCV20 alone or PCV15 followed by PPSV23 (≥1 year later) is recommended 1

Adults aged 19-64 years:

• Recommended for those with specific risk factors (see below) 1
• Adults with chronic medical conditions (alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes) should receive pneumococcal vaccination 1

Risk-Based Recommendations

Immunocompromising conditions:

• Adults with immunocompromising conditions (including chronic renal failure, asplenia, immunodeficiency, HIV, malignancy, immunosuppression) should receive pneumococcal vaccination regardless of age 1, 2
• For those with immunocompromising conditions who receive PCV15, PPSV23 should follow at a minimum interval of 8 weeks 1

Other high-risk conditions:

• Adults with CSF leaks or cochlear implants should receive pneumococcal vaccination regardless of age 1
• These patients should receive either PCV20 alone or PCV15 followed by PPSV23 1

Vaccination Strategies Based on Prior Vaccination History

For adults who previously received PPSV23 only:

• Administer a single dose of either PCV20 or PCV15 ≥1 year after the last PPSV23 dose 1
• No additional PPSV23 dose is needed after PCV15/PCV20 in this scenario 1

For adults who previously received PCV13 only:

• Administer either PCV20 ≥1 year after PCV13 or PPSV23 to complete the series 1
• For those with immunocompromising conditions, CSF leak, or cochlear implant, the minimum interval between PCV13 and PPSV23 is 8 weeks; for others, it's 1 year 1

For adults who received both PCV13 and PPSV23:

• If vaccination is complete according to prior recommendations, no additional doses are generally needed 1
• For those ≥65 years who completed their series with both PCV13 and PPSV23 (with PPSV23 given at age ≥65), shared clinical decision-making is recommended regarding additional PCV20 administration 1

For HSCT recipients:

• Administer 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, followed by a fourth dose ≥6 months after the third dose 1
• If PCV20 unavailable, give 3 doses of PCV15 followed by PPSV23 ≥1 year after HSCT 1

Clinical Considerations

Timing of vaccination:

• PCV and PPSV23 should not be administered during the same visit 1, 2
• When both are indicated, PCV should be administered before PPSV23 1
• The recommended interval between PCV15 and PPSV23 is ≥1 year for most adults 1
• A minimum interval of 8 weeks can be considered for adults with immunocompromising conditions, CSF leak, or cochlear implant 1

Efficacy considerations:

• PPSV23 has shown effectiveness in preventing invasive pneumococcal disease and reducing pneumonia severity in elderly patients 3, 4
• PCVs offer immunologic advantages compared to PPSV23 and contain additional serotypes not in PCV13 1
• PPSV23 contains 11 additional serotypes not in PCV13, accounting for 32-37% of invasive pneumococcal disease among adults ≥65 years 1, 2

Special populations:

• Residents of long-term care facilities should be assessed for pneumococcal vaccination status and vaccinated according to recommendations 5
• The most recent ACIP guidance (2024) has expanded recommendations to include PCV for all adults aged ≥50 years who are PCV-naïve 6

Common Pitfalls to Avoid

• Failing to assess vaccination history before administering pneumococcal vaccines 1
• Administering PCV13/15/20 and PPSV23 at the same visit (they should be separated) 1, 2
• Not waiting the appropriate interval between different pneumococcal vaccines (≥1 year for most adults, ≥8 weeks for high-risk) 1
• Overlooking the need for revaccination with PPSV23 in adults ≥65 years who received PPSV23 before age 65 1
• Forgetting that adults with certain chronic conditions (not just immunocompromising conditions) should receive pneumococcal vaccination 1