At what age is the pneumonia vaccine recommended for adults?

Pneumococcal Vaccination Age Recommendations for Adults

All adults should receive pneumococcal conjugate vaccine starting at age 50 years, with universal vaccination recommended at age 65 years for those who have not yet been vaccinated. 1

Current Age-Based Recommendations

Adults Aged 50-64 Years

• As of October 2024, ACIP recommends a single dose of pneumococcal conjugate vaccine (PCV20 or PCV21) for all adults aged ≥50 years who have never received a PCV. 1
• This represents an expansion from the previous age threshold of 65 years, now capturing adults in their 50s and early 60s. 1
• The preferred approach is a single dose of PCV20 alone for simplicity and comprehensive coverage. 2, 3

Adults Aged 65 Years and Older

• All adults aged ≥65 years should receive pneumococcal conjugate vaccine if they have not previously received one. 4, 2, 3
• The recommendation is for either PCV20 alone (preferred for simplicity) or PCV15 followed by PPSV23 at least 1 year later. 4, 5
• This is a universal recommendation regardless of underlying health conditions. 4, 2

Risk-Based Recommendations for Younger Adults (Ages 19-49)

While the universal age-based recommendation now starts at age 50, certain high-risk adults aged 19-49 years should receive pneumococcal vaccination earlier:

Chronic Medical Conditions (Ages 19-64)

• Adults with chronic heart disease (including congestive heart failure and cardiovascular diseases) should receive PCV. 2
• Adults with chronic lung disease should receive PCV. 2
• Adults with chronic liver disease should receive PCV. 2
• Adults with diabetes mellitus should receive PCV. 4, 2
• Current smokers have 2.8-4.1 times the risk for invasive pneumococcal disease and should receive PCV. 2

Immunocompromising Conditions (Ages 19-64)

• Adults with HIV infection, congenital or acquired immunodeficiencies, iatrogenic immunosuppression, generalized malignancy, Hodgkin disease, leukemia, lymphoma, multiple myeloma, sickle cell disease, or other hemoglobinopathies should receive PCV. 4, 2
• Solid organ transplant recipients should receive PCV. 2
• Adults with functional or anatomic asplenia should receive PCV. 4
• Adults with cerebrospinal fluid leak or cochlear implant should receive PCV. 4

Vaccination Schedule Based on Age and Prior History

Never Previously Vaccinated

• Adults aged ≥50 years who have never received any pneumococcal vaccine should receive a single dose of PCV20 (preferred option). 2, 3, 5
• Alternative: PCV15 followed by PPSV23 at least 1 year later. 5

Previously Received PPSV23 Only

• Adults aged ≥50 years who previously received only PPSV23 should receive a single dose of PCV20 at least 1 year after the last PPSV23 dose. 2, 3, 5
• This applies regardless of when the PPSV23 was given (before or after age 65). 2

Previously Received PCV13 Only

• Adults who previously received only PCV13 should receive a single dose of PCV20 at least 1 year after the PCV13 dose. 2, 3
• For immunocompromised adults, the minimum interval can be as short as 1 year. 2

Previously Received Both PCV13 and PPSV23

• For adults aged ≥65 years who completed the series with both PCV13 and PPSV23, shared clinical decision-making is recommended regarding administration of PCV20, which if given should be administered ≥5 years after the last pneumococcal vaccine dose. 4, 2, 5
• This is not a routine recommendation but may be considered on an individual basis. 4

Special Considerations for Immunocompromised Adults

Shortened Intervals

• For immunocompromised adults, the minimum interval between PCV15 and PPSV23 can be shortened to 8 weeks (rather than 1 year). 4, 2
• This applies to adults with chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, HIV infection, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplant, congenital or acquired asplenia, sickle cell disease, CSF leak, or cochlear implant. 4

PPSV23 Boosters

• Adults with immunocompromising conditions who receive PPSV23 may require a second PPSV23 dose ≥5 years after the first PPSV23 dose. 4, 5
• However, if PCV20 is used instead of PPSV23, no additional pneumococcal vaccines are needed. 2

Key Clinical Pitfalls to Avoid

Common Errors

• Do not wait until age 65 to vaccinate adults with chronic medical conditions or risk factors—they should be vaccinated starting at age 50 (or earlier if high-risk conditions are present). 1
• Do not administer PCV20 and PPSV23 on the same day—they should never be coadministered. 5
• Do not give additional PPSV23 doses after PCV20 administration—once PCV20 is given, the pneumococcal vaccination series is complete for most patients. 2, 5
• Do not revaccinate with PPSV23 after a dose given at age ≥65 years—only one PPSV23 dose is recommended after age 65 for most adults. 5

Timing Considerations

• Ensure at least 1 year has passed between PPSV23 and subsequent PCV20 administration (or 8 weeks for immunocompromised adults receiving PCV15 followed by PPSV23). 2, 3
• Not waiting the appropriate interval between different pneumococcal vaccines can reduce immune response. 3

Rationale for Age 50 Threshold

The expansion to age 50 in 2024 reflects:

• Recognition of persistent pneumococcal disease burden in adults with chronic conditions, particularly those with cardiovascular, liver, and pulmonary diseases and diabetes mellitus. 6
• Evidence that PCV13 demonstrated efficacy against vaccine-type invasive pneumococcal disease and pneumonia in adults aged ≥65 years, with immune responses in younger adults being comparable or better. 6
• The goal of providing direct immunologic benefit before adults reach the highest-risk age group. 1