Recommended Ages for Shingles and Pneumococcal Vaccines
Shingles Vaccine Recommendations
The shingles vaccine (Shingrix) is recommended for all adults aged 50 years and older, regardless of previous vaccination status with older shingles vaccines. 1
- Shingrix is administered as a two-dose series, with the second dose given 2-6 months after the first dose 2
- Approximately 70% of people complete the two-dose series within 6 months, and 80% complete it within 12 months of the initial dose 2
- The vaccine is highly effective, with grade 1 evidence (highest quality) supporting its use 1
- Even if a person previously received the older shingles vaccine (Zostavax), they should still receive the Shingrix two-dose series 1
Pneumococcal Vaccine Recommendations
For Adults 65 Years and Older:
A single dose of PCV20 (20-valent pneumococcal conjugate vaccine) is the preferred option for all adults aged 65 years and older who have not previously received a pneumococcal conjugate vaccine. 3, 4
- If PCV20 is unavailable, an alternative is to administer PCV15 followed by PPSV23 at least 1 year later 3, 4
- For adults ≥65 years who previously received PPSV23 only, administer a single dose of PCV20 after a ≥1 year interval since the last PPSV23 dose 3
- For adults ≥65 years who previously received PCV13, administer a single dose of PCV20 or PPSV23 at least 1 year after the PCV13 dose 4
For Adults 19-64 Years:
- Adults aged 50-64 years: As of October 2024, ACIP recommends a single dose of PCV for all PCV-naïve adults aged ≥50 years 5
- Adults aged 19-64 years with chronic medical conditions (alcoholism, chronic heart/lung/liver disease, diabetes, cigarette smoking): A single dose of PCV20 is recommended 1, 3
- Adults aged 19-64 years with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants: A single dose of PCV20 is recommended, with more aggressive scheduling compared to those with chronic conditions 3, 4
Special Considerations
For Pneumococcal Vaccines:
- Avoid administering different pneumococcal vaccines on the same day 4
- For patients who have already received both PCV13 and PPSV23, no additional pneumococcal vaccine doses are needed until age 65 1
- For patients with hematopoietic stem cell transplant (HSCT), a more intensive schedule is recommended: 3 doses of PCV20, 4 weeks apart starting 3–6 months after HSCT, followed by a fourth dose ≥6 months after the third dose 3
For Shingles Vaccine:
- The shingles vaccine should be given before starting biologic therapy or tofacitinib for conditions like rheumatoid arthritis 1
- Live attenuated vaccines (including older shingles vaccines) should not be used in patients currently receiving biologics 1
Common Pitfalls to Avoid
- Not waiting the appropriate interval between different pneumococcal vaccines can reduce immune response 3, 4
- Failing to complete the two-dose series of Shingrix significantly reduces protection against shingles 2
- Unnecessarily revaccinating with PPSV23 after the dose administered at age ≥65 years (no additional doses are recommended) 4
- Using outdated vaccination schedules that recommend PCV13 for all adults ≥65 years (this was changed in 2019) 4