Latest Pneumococcal Vaccine for Adults
The latest pneumococcal vaccines are PCV20 (Prevnar20) and PCV21 (CAPVAXIVE), both licensed in 2021-2024, with PCV20 being the most widely recommended single-dose option that provides comprehensive serotype coverage and completes the pneumococcal vaccination series for most adults. 1, 2
Current Vaccine Options Available
The pneumococcal vaccine landscape has evolved significantly, with four vaccines currently licensed for adult use:
- PCV20 (Prevnar20): 20-valent conjugate vaccine, licensed 2021, covers 20 serotypes 1
- PCV21 (CAPVAXIVE): 21-valent conjugate vaccine, newest option licensed 2024 2
- PCV15 (Vaxneuvance): 15-valent conjugate vaccine, licensed 2021 1
- PPSV23 (Pneumovax23): 23-valent polysaccharide vaccine, available since 1983 1, 3
Age-Based Recommendations
Adults Aged ≥50 Years (New 2024 Expansion)
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. 2 This represents a significant expansion from the previous age threshold of 65 years.
- Preferred option: Single dose of PCV20 or PCV21 alone 2
- Alternative option: PCV15 followed by PPSV23 at least 1 year later 2
- Once PCV20 or PCV21 is administered, the pneumococcal vaccination series is complete for most patients 4
Adults Aged 19-49 Years with Risk Factors
For younger adults with specific risk conditions, PCV is recommended:
Immunocompromising conditions (immediate vaccination indicated): 1, 5
- HIV infection
- Congenital or acquired immunodeficiencies
- Iatrogenic immunosuppression (chemotherapy, radiation, chronic corticosteroids)
- Generalized malignancy, leukemia, lymphoma, Hodgkin disease, multiple myeloma
- Solid organ transplant recipients
- Chronic renal failure or nephrotic syndrome
- Functional or anatomic asplenia (including sickle cell disease)
- Cerebrospinal fluid leak or cochlear implant
Chronic medical conditions (vaccination recommended): 1, 5, 4
- Chronic heart disease (including congestive heart failure and cardiomyopathies)
- Chronic lung disease (including COPD, emphysema, asthma)
- Chronic liver disease (including cirrhosis)
- Diabetes mellitus
- Alcoholism
- Cigarette smoking
Vaccination Strategy Based on Prior History
Never Vaccinated (Vaccine-Naïve)
Administer a single dose of PCV20 or PCV21 immediately—this completes the series. 1, 4, 2
Previously Received PPSV23 Only
Administer a single dose of PCV20 or PCV21 at least 1 year after the last PPSV23 dose. 1, 4 This approach provides the immunologic advantages of conjugate vaccines, including T-cell dependent responses and immunologic memory. 4
Previously Received PCV13 Only
Administer a single dose of PCV20 or PCV21 at least 1 year after the PCV13 dose. 1, 4 For adults aged 19-64 years with only chronic medical conditions (not immunocompromising conditions), an alternative is to complete the series with PPSV23 at least 1 year after PCV13. 1
Previously Received Both PCV13 and PPSV23
For adults who completed both PCV13 and PPSV23, shared clinical decision-making is recommended regarding administration of PCV20 or PCV21. 4 If the decision is made to vaccinate:
- Must wait at least 5 years since the last pneumococcal vaccine dose 1, 4
- This represents an optional additional dose, not a required vaccination 4
- Consider for patients with immunocompromising conditions who may benefit from additional serotype coverage 4
Special Populations
Hematopoietic Stem Cell Transplant (HSCT) Recipients
A 4-dose series of PCV20 is recommended, starting 3-6 months after HSCT: 1
- First 3 doses: Given 4 weeks apart
- Fourth dose: At least 6 months after the third dose OR at least 12 months after HSCT, whichever is later
- If chronic graft-versus-host disease develops, give a fourth dose of PCV15 instead of PPSV23 1
Immunocompromised Adults
The standard interval of at least 1 year between vaccines applies to immunocompromised patients when using PCV20 or PCV21. 5, 4 However, when using the PCV15/PPSV23 sequential strategy, the interval can be shortened to 8 weeks for immunocompromised patients. 5, 6
Key Advantages of PCV20/PCV21 Over Older Strategies
PCV20 and PCV21 offer significant practical advantages: 1, 4
- Single-dose regimen: Eliminates need for patients to return for a second dose
- Broader serotype coverage: PCV20 covers 20 serotypes vs. 13 in PCV13; PCV21 covers 21 serotypes 1, 2
- Conjugate vaccine benefits: Induces T-cell dependent immune responses and immunologic memory, unlike PPSV23 4
- Simplified recommendations: No need to track complex sequential schedules 7
- Series completion: Once administered, no additional pneumococcal vaccines are typically needed until age 65 (when recommendations should be reviewed) 5, 4
Common Pitfalls to Avoid
Do not administer PCV20/PCV21 too soon after prior pneumococcal vaccination: 4
- Must wait at least 1 year after PPSV23 or PCV13
- Must wait at least 5 years if both PCV13 and PPSV23 were previously given
Do not add PPSV23 after PCV20 or PCV21: 4
- Once PCV20 or PCV21 is administered, the series is complete
- Adding PPSV23 is unnecessary and not recommended
Do not confuse chronic medical conditions with immunocompromising conditions: 1, 5
- Chronic conditions (diabetes, heart disease, COPD) warrant vaccination but follow standard timing intervals
- Immunocompromising conditions may allow shorter intervals when using PCV15/PPSV23 strategy
Do not forget to reassess at age 50 and again at age 65: 5, 2
- Adults with chronic conditions vaccinated before age 50 should have recommendations reviewed at age 50
- All adults should have pneumococcal vaccination status reviewed at age 65
Clinical Timing Considerations
Vaccination can proceed immediately once a patient has clinically recovered from acute pneumonia—there is no required waiting period after pneumonia itself. 4 The timing depends entirely on prior vaccination history, not the pneumonia episode. 4
For patients planning to receive ZOSTAVAX (zoster vaccine), consider separating it from PNEUMOVAX 23 by at least 4 weeks, as concurrent administration may reduce immune response to ZOSTAVAX. 3