How many doses of Pneumovax 23 (pneumococcal polysaccharide vaccine) do you need?

From the Guidelines

Most adults need only one dose of Pneumovax 23 in their lifetime, but certain high-risk individuals may need a second dose at least 5 years after the first one. The recommendation for Pneumovax 23 dosing is based on the individual's risk factors and age. According to the updated recommendations of the Advisory Committee on Immunization Practices 1, all adults aged ≥65 years should receive 1 dose of PPSV23, and those who received their first dose before age 65 should get a second dose at least 5 years after the first one.

Key Considerations

• Adults with certain chronic health conditions, such as heart disease, lung disease, or diabetes, may need a second dose of Pneumovax 23 at least 5 years after the first one 1.
• Immunocompromised individuals, such as those with HIV, cancer, or kidney failure, may also require a second dose of Pneumovax 23 at least 5 years after the first one 1.
• The vaccine protects against 23 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and bloodstream infections.

Special Populations

• Adults with immunocompromising conditions, CSF leaks, or cochlear implants may require a different vaccination schedule, including the use of PCV13 in series with PPSV23 1.
• Shared clinical decision-making is recommended for PCV13 use in adults aged ≥65 years who do not have an immunocompromising condition, CSF leak, or cochlear implant and who have not previously received PCV13 1.

Vaccine Administration

• Pneumovax 23 should be administered at least 1 year after PCV13, and the recommended intervals between pneumococcal vaccines remain unchanged for adults without an immunocompromising condition, CSF leak, or cochlear implant 1.

From the FDA Drug Label

2.2 Administration Administer PNEUMOVAX 23 intramuscularly or subcutaneously into the deltoid muscle or lateral mid-thigh. Do not inject intravascularly or intradermally. Single-Dose Vial Administer a single 0.5-mL dose of PNEUMOVAX 23 using a sterile needle and syringe. 2.3 Revaccination The Advisory Committee on Immunization Practices (ACIP) has recommendations for revaccination against pneumococcal disease for persons at high risk who were previously vaccinated with PNEUMOVAX 23. Routine revaccination of immunocompetent persons previously vaccinated with a 23-valent vaccine, is not recommended.

Number of Doses:

• The standard dose is a single 0.5-mL dose of PNEUMOVAX 23.
• Revaccination is recommended for persons at high risk who were previously vaccinated with PNEUMOVAX 23, as per the Advisory Committee on Immunization Practices (ACIP) recommendations.
• Routine revaccination of immunocompetent persons previously vaccinated with a 23-valent vaccine is not recommended 2.

From the Research

Pneumovax 23 Dosing

• The number of doses of Pneumovax 23 needed is not explicitly stated in the provided studies, but the recommended use of Pneumovax 23 can be found in several studies 3, 4, 5, 6, 7.
• According to the study published in 2012, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine (PCV13) for adults aged ≥19 years with immunocompromising conditions, in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) 5.
• The study published in 2025 mentions that the ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years, but does not specify the number of doses of Pneumovax 23 needed 4.
• The study published in 2013 compared the immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine and a 23-valent pneumococcal polysaccharide vaccine in adults 70 years of age and older, but does not provide information on the number of doses of Pneumovax 23 needed 3.
• The study published in 2016 provides a review of pneumococcal vaccines, including Pneumovax 23, but does not specify the number of doses needed 6.
• The study published in 2007 discusses the potential issue of hyporesponsiveness with combined schedules of pneumococcal conjugate and polysaccharide vaccines, but does not provide information on the number of doses of Pneumovax 23 needed 7.

Recommended Use of Pneumovax 23

• Pneumovax 23 is recommended for use in adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown 4, 5.
• The vaccine is also recommended for adults with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants 5.