Pneumococcal Vaccination at Age 65 After Prior Vaccination
Yes, you need another pneumococcal vaccine now that you are 65, but the specific recommendation depends on which vaccine you received previously and when.
Determine Your Next Steps Based on Prior Vaccination
If You Received PPSV23 (Pneumovax 23) Only Before Age 65
You should receive a single dose of PCV20 (Prevnar 20) now, waiting at least 1 year after your last PPSV23 dose. 1, 2 This is the preferred approach because PCV20 provides broader serotype coverage and superior immune responses compared to repeating PPSV23. 3 After receiving PCV20, your pneumococcal vaccination series is complete and no additional doses are needed. 2, 4
If You Received PCV13 (Prevnar 13) Only Before Age 65
You should receive either a single dose of PCV20 at least 1 year after your PCV13 dose, OR a dose of PPSV23 at least 1 year after your PCV13 dose. 1 The PCV20 option is preferred because it completes your series with a single dose and provides comprehensive coverage. 2, 4 If you choose PPSV23 instead, no additional vaccines are needed afterward. 1
If You Received Both PCV13 and PPSV23 Before Age 65
You should receive a dose of PPSV23 now if you haven't yet received one at age ≥65 years. 1 The timing requirements are: at least 1 year since your last PCV13 dose AND at least 5 years since your last PPSV23 dose. 1 After this dose at age ≥65, your series is complete. 2
Alternatively, you and your provider may choose to administer PCV20 instead, but this requires shared clinical decision-making and a ≥5 year interval since your last pneumococcal vaccine. 1, 2
If You Never Received Any Pneumococcal Vaccine
You should receive a single dose of PCV20 now. 1, 2, 5 This is the simplest and preferred option for vaccine-naïve adults aged ≥65 years. 2 Alternatively, you could receive PCV15 followed by PPSV23 at least 1 year later, but the single PCV20 dose is more convenient. 1, 5
Key Timing Intervals to Remember
- PPSV23 to PCV20/PCV15: Wait at least 1 year 1, 2
- PCV13 to PCV20: Wait at least 1 year 1, 4
- PCV13 to PPSV23: Wait at least 1 year for immunocompetent adults 1
- PCV15 to PPSV23: Wait at least 1 year for immunocompetent adults 1
- When both PCV13 and PPSV23 were given previously: Wait at least 5 years before considering PCV20 1, 2
Special Considerations for High-Risk Conditions
If you have immunocompromising conditions (HIV, cancer, transplant, chronic renal failure, asplenia, immunosuppressive therapy), cerebrospinal fluid leak, or cochlear implant, the intervals between vaccines are shorter (≥8 weeks instead of ≥1 year between PCV and PPSV23). 1, 2 These high-risk conditions warrant more aggressive vaccination schedules to provide earlier protection. 2
Common Pitfalls to Avoid
Do not receive another dose of PPSV23 if you already received one at age ≥65 years. 2 Routine revaccination with PPSV23 after the dose given at age ≥65 is not recommended and provides no additional benefit. 6
Do not add PPSV23 after receiving PCV20. 2, 4 Once PCV20 is administered, your pneumococcal vaccination series is complete. 2, 4
Ensure adequate time intervals have passed. 1 Giving vaccines too close together can diminish immune responses, particularly when PPSV23 is given before a conjugate vaccine. 3
Why This Matters for Your Health
Pneumococcal disease causes significant morbidity and mortality in adults aged ≥65 years, including pneumonia, bloodstream infections, and meningitis. 5, 4 The newer conjugate vaccines (PCV20, PCV15) provide superior immune responses compared to PPSV23 alone, particularly in previously vaccinated individuals. 3 Completing your pneumococcal vaccination series at age 65 substantially reduces your risk of invasive pneumococcal disease and pneumonia-related hospitalizations. 1, 4