What is the recommended frequency for administering pneumonia vaccines, specifically pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV), to adults with certain medical conditions, such as heart disease, lung disease, or a weakened immune system, and to healthy adults 65 years and older?

Pneumococcal Vaccination Frequency for Adults

For most adults, pneumococcal vaccination is a one-time or two-time lifetime event, not a regularly repeated vaccine—the specific schedule depends entirely on age, immune status, and prior vaccination history. 1, 2

Healthy Adults ≥65 Years Without Prior Vaccination

• Administer a single dose of PCV20 (preferred) or PCV21 once at age 65 or older—this completes the series with no additional doses needed. 1, 3
• Alternatively, give PCV15 followed by PPSV23 at least 1 year later, which also completes the series. 4, 3
• No booster doses are recommended after completing this series. 1

Adults Aged 19-64 Years With Chronic Medical Conditions

These conditions include heart disease, lung disease (COPD, emphysema, asthma), liver disease, diabetes, alcoholism, or smoking history. 4

• Give a single dose of PCV20 now—this is the complete series. 2
• If previously received PPSV23 only: Give PCV20 at least 1 year after the last PPSV23 dose. 2
• If previously received PCV13 only: Give PCV20 at least 1 year after PCV13, which completes the series. 2
• Review vaccination status again when the patient turns 65 years old to determine if any additional doses are needed based on updated guidelines. 1, 2

Immunocompromised Adults (Any Age ≥19 Years)

This includes patients with chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, solid organ transplant, or complement deficiencies. 4, 1, 2

Initial Series:

• Option A: Single dose of PCV20 (completes series). 2
• Option B: PCV15 followed by PPSV23 at least 8 weeks later (note the shorter interval compared to immunocompetent patients). 1, 2

Booster Doses for Immunocompromised Patients:

• If using Option B (PCV15 + PPSV23): Give a second dose of PPSV23 at least 5 years after the first PPSV23 dose. 1
• This is the only scenario where PPSV23 is repeated before age 65. 1
• The critical distinction: immunocompromised patients need only ≥8 weeks between PCV and PPSV23, while immunocompetent patients need ≥1 year. 2

Adults Who Received PPSV23 Before Age 65

• Give PCV20 or PCV15 at least 1 year after the last PPSV23 dose. 1, 2
• If PCV15 is used, follow with PPSV23 at least 1 year later (≥8 weeks if immunocompromised). 1
• When the patient turns 65, if at least 5 years have passed since the last PPSV23 dose, give one final dose of PPSV23. 1
• No additional PPSV23 doses are given after the dose administered at age ≥65 years. 4, 1

Special High-Risk Conditions: Cochlear Implants or CSF Leaks

• These patients follow the same accelerated schedule as immunocompromised patients: PCV first, then PPSV23 at least 8 weeks later. 4
• Give a second PPSV23 dose at least 5 years after the first if the initial dose was given before age 65. 4

Updated 2024 Recommendations: Adults Aged 50-64 Years

• As of October 2024, ACIP now recommends a single dose of PCV for all adults aged ≥50 years who have never received a pneumococcal conjugate vaccine. 5
• This expands the age-based recommendation from 65 years down to 50 years. 5
• The same options apply: PCV20 alone, PCV21 alone, or PCV15 followed by PPSV23. 5

Key Timing Rules to Avoid Errors

• Never coadminister pneumococcal vaccines on the same day—this reduces immune response. 1, 3
• Wait at least 1 year between PCV and PPSV23 for immunocompetent patients; wait only 8 weeks for immunocompromised patients. 1, 2
• Not waiting the appropriate interval reduces immune response and wastes the vaccine. 2
• If vaccination status is uncertain, use verbal history and proceed with vaccination—do not delay waiting for records. 1

Common Pitfalls to Avoid

• Giving multiple PPSV23 boosters beyond what is recommended: There is insufficient evidence for safety with three or more doses. 1
• Overlooking risk factors in patients aged 50-64 years: These patients qualify for immediate vaccination rather than waiting until age 65. 2, 5
• Using the wrong interval between vaccines: The 8-week interval for immunocompromised patients reflects greater urgency for protection in high-risk individuals. 1
• Unnecessary revaccination: If PCV20 or PCV21 is used, the series is complete—no additional pneumococcal vaccination is generally needed. 2

Summary of Maximum Lifetime PPSV23 Doses

• Immunocompetent adults: Maximum of 1-2 doses total (one before age 65 if indicated, one at/after age 65). 1
• Immunocompromised adults: Maximum of 2-3 doses total (initial dose, booster at 5 years if given before age 65, final dose at/after age 65). 1
• The 5-year interval for PPSV23 boosters applies only to select high-risk immunocompromised populations who received their first dose before age 65. 1