How often should the Pneumococcal Conjugate Vaccine (PCV) and Pneumococcal Polysaccharide Vaccine (PPSV) be updated?

Pneumococcal Vaccination Update Frequency

For most adults, pneumococcal vaccination is a one-time series that does not require routine updates or boosters—once you complete the recommended series (either a single dose of PCV20 or PCV15 followed by PPSV23), no additional doses are needed. 1, 2

Standard Recommendations by Age and Risk Status

Healthy Adults ≥65 Years

• Single dose of PCV20 (preferred): This completes the pneumococcal vaccination series with no further doses required 1, 2
• Alternative: Single dose of PCV15 followed by PPSV23 at least 1 year later, then no additional doses 1, 3
• Critical point: If PPSV23 is given at age ≥65 years, no additional PPSV23 doses should ever be administered 1

Adults 19-64 Years with Chronic Medical Conditions

• Follow the same one-time series approach: PCV20 alone OR PCV15 followed by PPSV23 after ≥1 year 3
• Review vaccination status again when turning 65 years old to determine if additional doses are needed based on prior vaccination history 4

Adults with Immunocompromising Conditions

This is the only population that may require multiple doses:

• Initial series: PCV20 alone OR PCV15 followed by PPSV23 after ≥8 weeks (shorter interval than immunocompetent adults) 4, 3
• PPSV23 boosters: If using the PCV15 + PPSV23 strategy, a second PPSV23 dose is given ≥5 years after the first PPSV23 4
• Review at age 65: Reassess vaccination needs when reaching 65 years old 4

Immunocompromising conditions include: chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, and complement deficiencies 4, 1

Special Exception: Hematopoietic Stem Cell Transplant (HSCT)

• Four-dose PCV20 series: Three doses given 4 weeks apart starting 3-6 months post-transplant, then a fourth dose ≥6 months after the third dose OR ≥12 months post-HSCT (whichever is later) 2
• This is the only scenario requiring a multi-dose primary series in adults 2

Patients with Prior Vaccination History

Previously Received PPSV23 Only

• Give PCV20 or PCV15 after waiting ≥1 year from the last PPSV23 dose 4, 3
• If PCV20 is used, the series is complete 2

Previously Received PCV13 Only

• Non-immunocompromised: Add PPSV23 ≥1 year after PCV13, or switch to PCV20 ≥1 year after PCV13 4, 3
• Immunocompromised: Add PPSV23 ≥8 weeks after PCV13, then a second PPSV23 ≥5 years later 4

Previously Received Both PCV13 and PPSV23

• If already ≥65 years: Generally complete; consider PCV20 only through shared decision-making if ≥5 years have passed since last dose 2
• If <65 years with immunocompromising conditions: May give PCV20 ≥5 years after last dose 4

Critical Pitfalls to Avoid

• Do not give unnecessary PPSV23 boosters: Once PPSV23 is given at age ≥65 in immunocompetent adults, never repeat it 1
• Do not confuse PCV20 with PCV15: PCV20 stands alone and does not require PPSV23 follow-up, while PCV15 always requires PPSV23 2
• Do not co-administer pneumococcal vaccines: PCV and PPSV23 must be given on separate days with appropriate intervals 1, 3
• Do not use the same intervals for immunocompromised patients: They require shorter intervals (≥8 weeks vs ≥1 year) between PCV and PPSV23 4, 3

Historical Context

The 2023 ACIP guidelines represent a major simplification from prior recommendations. Before 2019, all adults ≥65 required both PCV13 and PPSV23; this changed to PPSV23 alone in 2019, and now (2023-2024) the preferred approach is single-dose PCV20 1. The older recommendation for PPSV23 revaccination every 5 years has been abandoned except in specific immunocompromised populations 5, 6.