How often should a patient get a pneumococcal (Pneumococcus) vaccine, such as Prevnar 13 (Pneumococcal conjugate vaccine) or Pneumovax 23 (Pneumococcal polysaccharide vaccine)?

Pneumococcal Vaccination Frequency for Adults

Primary Recommendation

For most adults aged ≥65 years, pneumococcal vaccination is a one-time series, not a recurring vaccine—specifically, a single dose of PCV20 (preferred) or PCV15 followed by PPSV23 at least 1 year later, with no additional doses needed thereafter. 1, 2, 3

Vaccination Schedule by Patient Category

Adults ≥65 Years (No High-Risk Conditions)

Never vaccinated:

• Single dose of PCV20 (preferred for simplicity) 2, 3
• Alternative: PCV15 followed by PPSV23 ≥1 year later 1
• This completes the series—no further doses needed 2

Previously received PPSV23 only:

• Single dose of PCV20 or PCV15 administered ≥1 year after last PPSV23 1, 2
• This completes the series—no additional doses 2

Previously received PCV13 only:

• Single dose of PCV20 or PPSV23 ≥1 year after PCV13 1
• Series is complete 1

Previously received both PCV13 and PPSV23 at age ≥65:

• No additional doses routinely recommended 1, 2
• Shared clinical decision-making may consider PCV20 ≥5 years after last dose, but this is optional 1

Adults 19-64 Years with Chronic Medical Conditions

Risk conditions include: chronic heart/lung/liver disease, diabetes, smoking, alcoholism 1, 3

Vaccination approach:

• Single dose of PCV20 (preferred) or PCV15 followed by PPSV23 ≥1 year later 1, 3
• Review vaccination status again at age 65 to determine if additional doses needed based on prior history 2
• This is NOT a recurring vaccine—it's a one-time series with reassessment at age 65 2

Adults with Immunocompromising Conditions (Any Age)

High-risk conditions include: asplenia, sickle cell disease, HIV, chronic renal failure, malignancies, immunosuppressive therapy, transplant recipients 1, 2, 3

Ages 19-64 years:

• PCV20 alone OR PCV15 followed by PPSV23 ≥8 weeks later (shorter interval than immunocompetent patients) 1, 3
• Second PPSV23 dose ≥5 years after first PPSV23 (only for this high-risk group) 1, 2
• Review again at age 65 for potential additional dosing 1, 2

Ages ≥65 years:

• If received PCV13 and 1 dose of PPSV23 before age 65: may give second PPSV23 ≥5 years after first PPSV23 1
• Maximum of 2 lifetime doses of PPSV23 for most immunocompromised patients 4

Critical Timing Intervals

Minimum intervals between vaccines:

• PCV15 to PPSV23: ≥1 year for immunocompetent; ≥8 weeks for immunocompromised 1, 3
• PPSV23 to PCV20/PCV15: ≥1 year 1, 2
• PCV13 to PCV20: ≥1 year 1
• Between PPSV23 doses (high-risk only): ≥5 years 1, 4
• Never co-administer pneumococcal vaccines on the same day 2

Common Pitfalls to Avoid

Do NOT give multiple PPSV23 boosters after age 65:

• Once PPSV23 is given at age ≥65, no additional PPSV23 doses are recommended for immunocompetent adults 1, 2
• The outdated practice of 5-year PPSV23 boosters applies only to select high-risk patients who received their first dose before age 65 2, 4

Do NOT revaccinate unnecessarily:

• Adults who completed PCV13 + PPSV23 series at age ≥65 are done—additional doses are optional at best 1, 2
• Not respecting minimum intervals reduces immune response 3

Do NOT confuse this with annual vaccines:

• Pneumococcal vaccination is a one-time series (or two-dose series for high-risk), not an annual or recurring vaccine like influenza 2, 3

Special Populations

Hematopoietic stem cell transplant recipients:

• Require 4 doses of PCV20 starting 3-6 months post-transplant 3
• This is the only population requiring more than 2 pneumococcal vaccine doses

Patients with prior PCV13 + PPSV23 before 2024 guidelines:

• May consider (but not required) single dose of PCV20 ≥5 years after last dose via shared decision-making 1
• This reflects broader serotype coverage of newer vaccines, not waning immunity

Key Guideline Evolution

The 2024 ACIP guidelines represent a significant shift from earlier recommendations 1:

• PCV20 and PCV21 now preferred over the older PCV13 + PPSV23 strategy 1, 2
• PCV13 is no longer routinely recommended since 2019 due to low disease incidence from pediatric herd immunity 1
• Emphasis on completing the series once rather than recurring boosters 2