Is a single dose or multiple doses of pneumococcal (PCV/Pneumococcal Conjugate Vaccine) vaccine recommended?

Pneumococcal Vaccination Recommendations: Single vs. Multiple Doses

For most adults, a single dose of the newest pneumococcal conjugate vaccine (PCV21, PCV20, or PCV15) is recommended, with an additional PPSV23 dose only required in specific circumstances based on age and risk factors. 1

General Recommendations by Population

Adults ≥65 Years

• For adults ≥65 years with no prior pneumococcal vaccination: A single dose of PCV21, PCV20, or PCV15 is recommended 1
• If PCV15 is administered, a single dose of PPSV23 should follow ≥1 year later 1
• For adults ≥65 years with prior PPSV23: A single dose of PCV21, PCV20, or PCV15 is recommended ≥1 year after the last PPSV23 dose 1

Adults 19-64 Years with Immunocompromising Conditions

• For immunocompromised adults with no prior pneumococcal vaccination: A single dose of PCV21, PCV20, or PCV15 is recommended 1, 2
• If PCV15 is administered, a single dose of PPSV23 should follow ≥8 weeks later (shorter interval than non-immunocompromised) 1, 2
• If previously received PCV13 only: A single dose of PCV21, PCV20, or PPSV23 is recommended 1

Adults 19-64 Years with Chronic Medical Conditions

• For adults with chronic conditions with no prior pneumococcal vaccination: A single dose of PCV21, PCV20, or PCV15 is recommended 1
• If PCV15 is administered, a single dose of PPSV23 should follow ≥1 year later 1

Special Considerations Based on Vaccination History

For Those with Prior Pneumococcal Vaccination

• If previously received PPSV23 only: Wait ≥1 year after PPSV23 before administering PCV21, PCV20, or PCV15 1
• If previously received PCV13 and PPSV23 at age ≥65 years: Shared clinical decision-making is recommended regarding administration of a single dose of PCV21 or PCV20 ≥5 years after the last pneumococcal vaccine dose 1
• If PCV21 or PCV20 is used in place of any dose of PPSV23, the series is complete, and no additional pneumococcal vaccine doses are needed 1

For Hematopoietic Stem Cell Transplant Recipients

• A specialized multi-dose schedule is required: 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 3

Important Clinical Considerations

• The optimal order of administration when both vaccines are needed is PCV first, followed by PPSV23 after the appropriate interval 2, 4
• For immunocompromised adults: PCV followed by PPSV23 with ≥8 weeks interval 2, 4
• For non-immunocompromised adults: PCV followed by PPSV23 with ≥1 year interval 2, 4
• Sequential PCV13/PPSV23 vaccination has shown the highest effectiveness (80.3%) against pneumococcal pneumonia in adults aged 65-74 years 5

Common Pitfalls to Avoid

• Failing to check the patient's prior pneumococcal vaccination history, which determines the appropriate timing of vaccination 2, 3
• Using incorrect intervals between different pneumococcal vaccines for immunocompromised vs. non-immunocompromised patients 2, 4
• Administering unnecessary additional doses when PCV21 or PCV20 has been given 1
• Overlooking the need for PPSV23 after PCV15 in high-risk individuals 1, 2

Recent Updates

• The 2024 ACIP recommendations now include PCV21 (CAPVAXIVE) as an option, which contains eight additional pneumococcal serotypes not included in previously recommended vaccines 1, 6
• Recent recommendations have simplified the approach by recommending a single dose of conjugate vaccine for most adults 7, 6
• In October 2024, ACIP expanded age-based PCV recommendations to include all adults aged ≥50 years 6