At what age should you get the Pneumovax (Pneumococcal Polysaccharide Vaccine) vaccination?

When to Get Pneumovax (PPSV23)

All adults should receive pneumococcal vaccination starting at age 50 years, with the preferred approach being a single dose of PCV20 or PCV21 (newer conjugate vaccines) rather than starting with PPSV23. 1

Current Age-Based Recommendations

Adults Age 50 and Older

• Universal pneumococcal vaccination is now recommended for all adults aged ≥50 years (expanded from the previous age 65 threshold in October 2024). 1
• The preferred initial vaccination is PCV20 alone or PCV21 alone (single dose, no additional vaccines needed). 2, 3
• An alternative approach is PCV15 followed by PPSV23 at least 1 year later. 2, 3
• PPSV23 is FDA-approved for use in persons 50 years of age or older. 4

Adults Age 19-49 Years

• Pneumococcal vaccination is only indicated if specific risk factors are present, not routinely recommended for healthy adults in this age group. 2

Risk-Based Indications for Adults Under 50

Chronic Medical Conditions (Ages 19-64)

• Chronic heart disease (including congestive heart failure and cardiomyopathies). 5, 2
• Chronic lung disease (including COPD, emphysema, and asthma). 5, 2
• Diabetes mellitus. 5, 2
• Chronic liver disease. 5, 2
• Chronic renal failure or nephrotic syndrome. 5, 2
• Alcoholism. 5, 2
• Current cigarette smoking. 5, 2

Immunocompromising Conditions (Ages 19-64)

• HIV infection. 5, 2
• Congenital or acquired immunodeficiencies (including B- or T-lymphocyte deficiency, complement deficiencies, phagocytic disorders). 5, 2
• Congenital or acquired asplenia or sickle cell disease. 5, 2
• Generalized malignancy, Hodgkin disease, leukemia, lymphoma, or multiple myeloma. 5, 2
• Solid organ transplant. 5, 2
• Iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy). 5, 2

Anatomic/Functional Conditions (Ages 19-64)

• Cochlear implant. 2
• Cerebrospinal fluid (CSF) leak. 2

Vaccination Schedule Based on Prior History

Never Vaccinated

• Single dose of PCV20 or PCV21 (preferred for simplicity). 2, 3
• Alternative: PCV15 followed by PPSV23 ≥1 year later. 2, 3

Previously Received PPSV23 Only

• Single dose of PCV20, PCV21, or PCV15 at least 1 year after the last PPSV23 dose. 5, 3
• No additional PPSV23 is needed after receiving the conjugate vaccine. 5
• This applies even if PPSV23 was given before age 65. 3

Previously Received PCV13 Only

• Single dose of PCV20 or PCV21 at least 1 year after PCV13. 5
• Alternative: PPSV23 at least 1 year after PCV13 (then review recommendations again at age 65). 5

Previously Received Both PCV13 and PPSV23

• No additional vaccines needed if under age 65. 5
• Review pneumococcal vaccine recommendations again when turning age 65. 5
• At age ≥65, shared clinical decision-making may consider PCV20 or PCV21 ≥5 years after the last pneumococcal vaccine dose. 3

Special Timing Considerations

Immunocompromised Patients

• When using the PCV15-PPSV23 series, the minimum interval can be shortened to ≥8 weeks (instead of ≥1 year) for adults with immunocompromising conditions, CSF leak, or cochlear implant. 5, 3
• This shorter interval minimizes the time at risk for invasive pneumococcal disease in high-risk populations. 3
• A second dose of PPSV23 may be given ≥5 years after the first PPSV23 dose for immunocompromised adults aged 19-64 years. 3

Adults Age ≥65 Who Received PPSV23 Before Age 65

• Another dose of PPSV23 should be given at age ≥65 years if at least 5 years have passed since the previous dose. 3
• However, the current preferred approach is to give PCV20 or PCV21 instead, at least 1 year after the last PPSV23. 3

Adults Age ≥65 Who Received PPSV23 at Age ≥65

• Only a single dose of PPSV23 is recommended after age 65, without additional boosters. 3
• Routine revaccination with PPSV23 is not recommended for immunocompetent persons. 4

Important Clinical Caveats

Why Conjugate Vaccines Are Now Preferred Over PPSV23

• PCV vaccines provide immunologic advantages over PPSV23, including better immune memory and longer duration of protection. 5
• PPSV23 has limited duration of protection, which is why the newer conjugate vaccines are now preferred as initial vaccination. 5
• The widespread use of conjugate vaccines has led to near-disappearance of vaccine serotypes from the population, making PPSV23-only approaches less relevant. 6

Vaccine Administration

• PCV and PPSV23 should never be administered on the same day. 5, 3
• For patients requiring elective splenectomy or initiation of immunosuppressive therapy, vaccination should be completed at least 2 weeks before surgery or therapy. 3

Diminished Response in Special Populations

• Immunocompromised individuals may have diminished immune response to pneumococcal vaccines. 4
• Elderly individuals may experience higher rates of systemic adverse reactions following revaccination (33.1%) compared to primary vaccination (21.7%). 4
• Children under 2 years of age do not develop an effective immune response to PPSV23 and should not receive it. 4

Hematopoietic Stem Cell Transplant Recipients

• Require a special 4-dose series starting 3-6 months after transplant: 3 doses of PCV20 given 4 weeks apart, followed by a fourth dose ≥6 months after the third dose or ≥12 months after transplant, whichever is later. 5