Pneumococcal Vaccination Schedule for Adults
For adults, the recommended pneumococcal vaccination schedule is a single dose of PCV20 (20-valent pneumococcal conjugate vaccine) for all adults aged 65 years and older, as well as adults 19-64 years with risk conditions who have not previously received a pneumococcal conjugate vaccine. 1
General Recommendations by Age Group
Adults ≥65 years (all adults)
- For those who have never received a pneumococcal vaccine or received only PCV7: Administer a single dose of PCV20 1
- For those who previously received PPSV23 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 1
- For those who previously received PCV13 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PCV13 dose 1
- For those who received both PCV13 and PPSV23 but have not yet received PPSV23 at age ≥65 years: Administer a single dose of PCV20 after a ≥5 year interval since the last PCV13 or PPSV23 dose 1
Adults 19-64 years with chronic medical conditions
- Chronic conditions include: alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, or diabetes mellitus 1
- For those who have never received a pneumococcal vaccine or received only PCV7: Administer a single dose of PCV20 1
- For those who previously received PPSV23 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 1
- For those who previously received PCV13 only: Administer a single dose of PCV20 after a ≥1 year interval since the last dose 1
- For those who received both PCV13 and PPSV23: No vaccines are recommended until age 65 1
Adults 19-64 years with immunocompromising conditions
- Immunocompromising conditions include: chronic renal failure, asplenia, immunodeficiency, HIV infection, malignancy, immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease, and solid organ transplant 1
- For those who have never received a pneumococcal vaccine: Administer a single dose of PCV20 1
- For those who previously received PPSV23 only: Administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 1
Special Populations
Adults with hematopoietic stem cell transplant (HSCT)
- For those who have received no pneumococcal vaccines after HSCT: Administer 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 or ≥12 months after HSCT, whichever is later 1
- For those who received ≥1 dose of PCV13 or PCV15 after HSCT but have not received all 4 doses: Administer ≥1 dose of PCV20 to complete the 4-dose PCV series 1
Alternative Schedule (if PCV20 is not available)
If PCV20 is not available, PCV15 followed by PPSV23 can be used:
- For adults ≥65 years without immunocompromising conditions: Administer a single dose of PCV15, then after a ≥1 year interval, administer a single dose of PPSV23 1
- For adults ≥65 years with immunocompromising conditions: Administer a single dose of PCV15, then after ≥8 weeks, administer a single dose of PPSV23 1
- For adults 19-64 years with chronic medical conditions: Administer a single dose of PCV15, then after a ≥1 year interval, administer a single dose of PPSV23 1
Important Clinical Considerations
- The most recent ACIP recommendations (2023) prioritize the use of PCV20 as a single dose for most adults, which simplifies the vaccination schedule compared to previous recommendations 1
- Pneumococcal vaccination is particularly important for older adults and those with chronic conditions as they have a persistent pneumococcal disease burden 2
- For patients who have already received PCV13 and PPSV23 at age ≥65 years, providers may choose to administer PCV20 after a ≥5 year interval since the last pneumococcal vaccine dose 1
- Vaccine tracking and reminder systems have been shown to facilitate high vaccination coverage, approaching the Healthy People 2010 national objectives 3
- The recommendations for pneumococcal vaccination continue to evolve, with recent evidence supporting expanded use of pneumococcal conjugate vaccines in adults 4
Common Pitfalls to Avoid
- Failing to recognize that adults with diabetes mellitus should receive pneumococcal vaccination - coverage should be over 50% in younger age groups and 75% in those 60-64 years of age 3
- Not waiting the appropriate interval between different pneumococcal vaccines, which can reduce immune response 1
- Overlooking the need for pneumococcal vaccination in younger adults with risk factors such as chronic heart, liver, or lung diseases 2
- Not recognizing that the vaccination schedule differs for immunocompromised patients compared to those with chronic medical conditions 1
- Missing opportunities to vaccinate adults during routine healthcare visits, which contributes to suboptimal coverage rates 3