What are the recommended schedules for the 13‑valent pneumococcal conjugate vaccine (PCV13) and the 23‑valent pneumococcal polysaccharide vaccine (PPSV23) in adults (≥65 years, 19‑64 years with high‑risk or moderate‑risk conditions) and in children?

Pneumococcal Vaccination Regimens for Adults and Children

Adults ≥65 Years (Vaccine-Naïve or Unknown History)

Administer a single dose of PCV20 as the preferred option, which completes the pneumococcal vaccination series with no additional doses needed. 1, 2

• Alternative approach: Give PCV15 followed by PPSV23 at least 1 year later if PCV20 is unavailable 1
• Once the series is completed at age ≥65 years, no additional pneumococcal vaccines are recommended for the patient's lifetime 2, 3

Adults ≥65 Years with Prior Vaccination History

Previously received PPSV23 only

• Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose, completing the series 1, 2
• Alternative: Give PCV15 at least 1 year after PPSV23 (no additional PPSV23 needed afterward) 1

Previously received PCV13 only

• Administer a single dose of PCV20 at least 1 year after the PCV13 dose, completing the series 1, 4
• Alternative: Give PPSV23 at least 1 year after PCV13 1

Previously received both PCV13 and PPSV23 at age ≥65 years

• No additional vaccines are routinely recommended 1
• Shared clinical decision-making may be considered for PCV20 administration ≥5 years after the last pneumococcal vaccine dose, particularly for immunocompromised patients 1, 2, 4

Adults Aged 19-64 Years with High-Risk Conditions*

High-risk conditions include: chronic renal failure, asplenia (congenital or acquired), immunodeficiencies, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, solid organ transplant, CSF leak, or cochlear implant 1

Vaccine-naïve or unknown history

• Option A: Single dose of PCV20 1, 4
• Option B: PCV15 followed by PPSV23 at least 8 weeks later (note the shorter interval for immunocompromised patients) 1, 2
• Review vaccination status again when the patient turns 65 years old 1

Previously received PPSV23 only

• Administer PCV20 or PCV15 at least 1 year after the last PPSV23 dose 1, 2

Previously received PCV13 only

• Administer PPSV23 at least 8 weeks after PCV13 (for immunocompromised patients) 1, 2
• A second dose of PPSV23 is recommended 5 years after the first PPSV23 dose for immunocompromised patients who received their first dose before age 65 2, 3
• Alternative: Give PCV20 at least 1 year after PCV13, completing the series 1, 4

Previously received both PCV13 and PPSV23

• For immunocompromised patients: May give PCV20 at least 5 years after the last pneumococcal vaccine dose 1, 2
• Otherwise, no vaccines recommended until age 65 1

Adults Aged 19-64 Years with Moderate-Risk Conditions†

Moderate-risk conditions include: chronic heart disease, chronic lung disease (including COPD), chronic liver disease, diabetes mellitus, alcoholism, or cigarette smoking 1, 4

Vaccine-naïve or unknown history

• Option A: Single dose of PCV20 1, 4
• Option B: PCV15 followed by PPSV23 at least 1 year later (note the longer interval compared to immunocompromised patients) 1
• Review vaccination status again when the patient turns 65 years old 1

Previously received PPSV23 only

• Administer PCV20 or PCV15 at least 1 year after the last PPSV23 dose 1, 2

Previously received PCV13 only

• Administer PPSV23 at least 1 year after PCV13 1
• Alternative: Give PCV20 at least 1 year after PCV13, completing the series 1, 4

Previously received both PCV13 and PPSV23

• No vaccines recommended at this time; review again at age 65 1

Adults Aged 50-64 Years (New 2024 Recommendation)

All adults aged ≥50 years who have never received a pneumococcal conjugate vaccine should receive a single dose of PCV20, PCV21, or PCV15 5

• This represents an expansion of the age-based recommendation from ≥65 years to ≥50 years as of October 2024 5
• The same vaccination schedules based on prior vaccination history apply as outlined above 5

Critical Timing Intervals to Remember

Standard intervals (immunocompetent adults)

• Between PCV and PPSV23: At least 1 year 1, 2
• Between PPSV23 and subsequent PCV: At least 1 year 1, 2
• Between PCV13 and PCV20: At least 1 year 1, 4
• Between two PPSV23 doses: At least 5 years (only for specific high-risk patients who received first dose before age 65) 2, 3

Shortened intervals (immunocompromised adults)

• Between PCV and PPSV23: At least 8 weeks 1, 2
• Between two PPSV23 doses: At least 5 years 2, 3

Extended intervals

• For patients who completed PCV13 + PPSV23 series and are considering PCV20: At least 5 years after the last pneumococcal vaccine dose 1, 2, 4

Special Population: Hematopoietic Stem Cell Transplant Recipients

Administer a 4-dose series of PCV20 starting 3-6 months after transplant 4

• First 3 doses: Given 4 weeks apart 4
• Fourth dose: At least 6 months after the third dose OR at least 12 months after HSCT, whichever is later 4

Common Pitfalls and How to Avoid Them

Never co-administer pneumococcal vaccines on the same day

• PCV and PPSV23 must be given on separate occasions to optimize immune response 2, 4

Do not give additional PPSV23 after the dose administered at age ≥65 years

• Once PPSV23 is given at age ≥65, no further PPSV23 doses are recommended 2, 3
• Maximum lifetime PPSV23 doses: 1-2 for immunocompetent adults, 2-3 for immunocompromised adults 2

Once PCV20 is administered, the series is complete

• Do not add PPSV23 after PCV20—this is unnecessary and not recommended 2, 4

Use verbal history if vaccination records are unavailable

• Never delay vaccination waiting for complete medical records 2
• Proceed with vaccination based on patient's verbal history if indicated 2

Distinguish between 8-week and 1-year intervals

• The 8-week interval between PCV and PPSV23 applies only to immunocompromised patients 1, 2
• All other patients require at least 1 year between PCV and PPSV23 1, 2

Review vaccination status at age 65

• For patients vaccinated before age 65 with chronic or immunocompromising conditions, reassess pneumococcal vaccination needs when they turn 65 1, 2

---

*High-risk conditions warrant more aggressive vaccination schedules with shorter intervals and potential for additional PPSV23 doses.

†Moderate-risk conditions follow standard intervals but still require pneumococcal vaccination before age 65.