If I received Pneumococcal Conjugate Vaccine (PCV) 13, which pneumonia shot am I due for, Pneumococcal Polysaccharide Vaccine (PPSV) 23?

Pneumococcal Vaccination After PCV13

If you have received PCV13, you should complete your pneumococcal vaccination series with either PPSV23, PCV20, or PCV21, depending on your age, risk factors, and when you received PCV13. 1

For Adults Aged ≥65 Years Who Received PCV13 Only

Complete your series with either PCV20, PCV21, or PPSV23 administered ≥1 year after your PCV13 dose. 1

• The 2023 ACIP guidelines provide PCV20 as an alternative option to PPSV23 for completing the series, offering broader serotype coverage with the immunologic advantages of conjugate vaccines over polysaccharide vaccines 1
• The 2024 ACIP guidelines added PCV21 as another option, though PCV21 does not contain serotype 4, which may be important in certain geographic areas (particularly the western United States) 1
• For immunocompromised adults (including those with chronic renal failure, immunodeficiency, HIV, malignancy, or transplant), CSF leak, or cochlear implant: the minimum interval between PCV13 and PPSV23 is reduced to ≥8 weeks 1

For Adults Aged 19-64 Years With Chronic Medical Conditions

If you have chronic conditions (alcoholism, chronic heart/liver/lung disease, diabetes, or cigarette smoking) and received PCV13 only, complete your series with PCV21, PCV20, or PPSV23 ≥1 year after PCV13. 1

• The 2024 guidelines recommend a single dose of PCV21, PCV20, or PPSV23 for adults with chronic medical conditions who previously received only PCV13 1
• If you have immunocompromising conditions (not just chronic medical conditions), you should receive PPSV23 ≥8 weeks after PCV13, or alternatively PCV20/PCV21 ≥1 year after PCV13 1

Rationale for These Recommendations

The choice between PPSV23 and newer conjugate vaccines (PCV20/PCV21) reflects evolving evidence about immunologic advantages of conjugate vaccines. 1

• Phase III clinical trials demonstrated that PCV20 administered to adults who received PCV13 ≥6 months prior was safe and immunogenic 1
• Research shows that initial vaccination with PCV13 establishes an immune state that results in recall responses upon subsequent vaccination with either conjugate or polysaccharide vaccines 2
• In contrast, initial PPSV23 vaccination results in diminished responses to subsequent PPSV23 doses, whereas PCV13 does not impair responses to subsequent PCV13 3, 2
• PPSV23 provides the broadest serotype coverage (23 serotypes), but conjugate vaccines offer superior immunologic memory and T-cell dependent responses 1

Key Clinical Considerations

The timing of your next vaccine depends critically on your risk category:

• Standard risk adults ≥65 years: Wait ≥1 year after PCV13 for any completion vaccine 1
• Immunocompromised adults, CSF leak, or cochlear implant: PPSV23 can be given as early as ≥8 weeks after PCV13 1
• If choosing PCV20 or PCV21 after both PCV13 and PPSV23: Wait ≥5 years after the last pneumococcal vaccine dose 1

Common pitfall: Do not administer PPSV23 before the recommended interval after PCV13, as this may reduce the immunologic benefit of the conjugate vaccine priming effect 3, 2