PPSV23 Vaccination Dose Series
For most adults, PPSV23 is administered as a single dose, with a second dose only for specific high-risk populations who received their first dose before age 65 years. 1
Standard Dosing for Adults ≥65 Years
- Adults who receive PPSV23 at age ≥65 years should receive only a single dose without additional boosters. 2, 1
- Routine revaccination of immunocompetent persons previously vaccinated with PPSV23 is not recommended. 1
- The single 0.5-mL dose is administered intramuscularly or subcutaneously. 1
Two-Dose Series for High-Risk Adults <65 Years
- A second dose of PPSV23 is recommended 5 years after the first dose for persons aged 19-64 years with immunocompromising conditions (chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, complement deficiencies). 2, 1
- Adults who received PPSV23 before age 65 for any indication should receive another dose at age ≥65 years, if at least 5 years have passed since the previous dose. 2
- This creates a maximum of two lifetime doses of PPSV23 for high-risk individuals: one before age 65 and one at/after age 65. 2
Current Preferred Approach: Conjugate Vaccines First
- The 2024 ACIP guidelines now recommend newer conjugate vaccines (PCV20, PCV21, or PCV15) as the preferred initial vaccination for adults ≥50 years, not PPSV23. 2, 3
- For adults who previously received only PPSV23, a single dose of PCV20, PCV21, or PCV15 should be administered ≥1 year after the last PPSV23 dose, completing the series without additional PPSV23. 4, 2
- When PCV15 is used in the series, it should be followed by PPSV23 at ≥1 year interval (or ≥8 weeks for immunocompromised patients). 4, 5
Important Clinical Caveats
- ACIP does not recommend multiple revaccinations due to uncertainty regarding clinical benefit and safety. 2
- Most adults receive only one or two lifetime doses of PPSV23, depending on age and risk factors, with the 5-year interval applying only to select high-risk populations who received their first dose before age 65. 2
- For subjects aged 65 years or older, systemic adverse reactions determined to be vaccine-related were higher following revaccination (33.1%) than following initial vaccination (21.7%), supporting the recommendation against routine revaccination. 1
Special Populations Requiring Shorter Intervals
- For immunocompromised adults requiring both PCV and PPSV23, the minimum interval between vaccines is ≥8 weeks (rather than ≥1 year for immunocompetent adults). 4, 5
- This shorter interval applies to adults with chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, and complement deficiencies. 2, 5