Pneumococcal Vaccination Recommendations

Introduction to Pneumococcal Vaccination

The American College of Physicians and the Advisory Committee on Immunization Practices (ACIP) recommend completing the pneumococcal vaccination series with either PPSV23, PCV20, or PCV21, depending on age, risk factors, and the timing of the PCV13 dose 1, 2

For adults aged ≥65 years who received PCV13 only, the ACIP guidelines recommend completing the series with either PCV20, PCV21, or PPSV23 administered ≥1 year after the PCV13 dose 1, 2
The ACIP guidelines provide PCV20 as an alternative option to PPSV23 for completing the series, offering broader serotype coverage with the immunologic advantages of conjugate vaccines over polysaccharide vaccines 1, 2
For immunocompromised adults, including those with chronic renal failure, immunodeficiency, HIV, malignancy, or transplant, the minimum interval between PCV13 and PPSV23 is reduced to ≥8 weeks 1, 2

For adults aged 19-64 years with chronic medical conditions who received PCV13 only, the ACIP guidelines recommend completing the series with PCV21, PCV20, or PPSV23 ≥1 year after PCV13 3
The 2024 guidelines recommend a single dose of PCV21, PCV20, or PPSV23 for adults with chronic medical conditions who previously received only PCV13 3

The choice between PPSV23 and newer conjugate vaccines (PCV20/PCV21) reflects evolving evidence about the immunologic advantages of conjugate vaccines 1, 2
PPSV23 provides the broadest serotype coverage (23 serotypes), but conjugate vaccines offer superior immunologic memory and T-cell dependent responses 1, 2

Standard risk adults ≥65 years should wait ≥1 year after PCV13 for any completion vaccine 1, 2
Immunocompromised adults, those with CSF leak, or cochlear implant can receive PPSV23 as early as ≥8 weeks after PCV13 1, 2
If choosing PCV20 or PCV21 after both PCV13 and PPSV23, individuals should wait ≥5 years after the last pneumococcal vaccine dose 1, 2

The American College of Physicians and the Advisory Committee on Immunization Practices (ACIP) recommend completing the pneumococcal vaccination series with a conjugate vaccine after prior PPSV23 administration, with a minimum interval of at least 1 year after the last PPSV23 dose for immunocompetent adults, including those ≥65 years 4, 5
The Centers for Disease Control and Prevention (CDC) and ACIP recommend that immunocompromised adults, including those with chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, or complement deficiencies, can receive a conjugate vaccine at least 8 weeks after PPSV23 if clinically indicated 6, 7

The ACIP recommends administering PCV20 or PCV21 as a single dose to complete the vaccination series without requiring additional PPSV23, providing broader serotype coverage and superior immunologic memory compared to polysaccharide vaccines 4, 5
An alternative option is PCV15 followed by PPSV23 at least 1 year later for immunocompetent adults or at least 8 weeks later for immunocompromised adults 4, 5

The CDC and ACIP recommend that adults ≥65 years who received PPSV23 before age 65 should receive one additional pneumococcal vaccine dose at age ≥65 years, preferably PCV20 or PCV21, administered at least 1 year after the last PPSV23 dose 8, 5
The CDC and ACIP also recommend that adults who received PPSV23 at age ≥65 years do not need additional pneumococcal vaccines after completing with PCV20/PCV21 at least 1 year later 5

The ACIP prioritizes conjugate vaccines over PPSV23 as the preferred initial vaccination strategy, and adding a conjugate vaccine after PPSV23 provides enhanced immunologic response, broader serotype coverage, and no additional PPSV23 needed 4, 5