PPSV23 Is NOT Given Every 5 Years as a Routine Schedule
PPSV23 is not routinely administered every 5 years; most adults receive only one or two lifetime doses depending on age and risk factors, with specific 5-year intervals applying only to select high-risk populations who received their first dose before age 65. 1, 2
Standard PPSV23 Dosing for Most Adults
Adults who receive PPSV23 at age ≥65 years need only a single dose with no additional boosters—this is a one-time vaccination. 2, 3
Adults who received PPSV23 before age 65 for any indication should receive one additional dose at age ≥65 years, but only if at least 5 years have passed since the previous dose. 2
The 5-year interval is not a recurring schedule but rather a minimum waiting period between the first and second (final) dose for those vaccinated before reaching age 65. 1
The 5-Year Rule: When It Actually Applies
A second dose of PPSV23 is recommended 5 years after the first dose only for persons aged 19-64 years with specific high-risk conditions such as asplenia or immunocompromising conditions. 2
For immunocompromised adults aged 19-64 years who received both PCV13 and one dose of PPSV23, a second PPSV23 dose may be given ≥5 years after the first PPSV23 dose (not every 5 years indefinitely). 1, 2
When adults with prior vaccination history reach age 65, their pneumococcal vaccination status should be reviewed, but this does not mean automatic revaccination every 5 years. 1
Why Not Every 5 Years?
The ACIP explicitly does not recommend multiple revaccinations due to uncertainty regarding clinical benefit and safety. 2
Research demonstrates that repeated PPSV23 administration actually yields lower immune responses compared to initial vaccination, a phenomenon called hyporesponsiveness. 4, 5
After receiving PPSV23 at age ≥65 years, no additional doses are recommended, and unnecessary revaccination should be avoided. 2, 3
Current Preferred Approach: Conjugate Vaccines First
The 2024 ACIP guidelines now recommend newer conjugate vaccines (PCV20, PCV21, or PCV15) as the preferred initial vaccination for adults ≥65 years, not PPSV23. 1, 2
For adults who previously received only PPSV23, a single dose of PCV20, PCV21, or PCV15 should be administered ≥1 year after the last PPSV23 dose, completing the series. 1
Once PCV20 or PCV21 is administered, the pneumococcal vaccination series is complete with no additional doses needed. 2, 6
Common Pitfall to Avoid
The misconception that PPSV23 requires 5-yearly boosters likely stems from confusing the one-time 5-year interval (between a pre-65 dose and a post-65 dose) with an ongoing schedule. This is incorrect—PPSV23 is not like tetanus boosters; it's a limited series, not a recurring vaccination. 2