Pneumococcal Vaccine Recommendations for Adults

Introduction to Pneumococcal Vaccines

The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination for all adults aged ≥65 years and adults aged 19-64 years with certain risk conditions, using the newly approved 21-valent pneumococcal conjugate vaccine (PCV21) as a recommended option 1
Four pneumococcal vaccines are currently licensed for use in adults in the United States, including 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), 15-valent pneumococcal conjugate vaccine (PCV15), 20-valent pneumococcal conjugate vaccine (PCV20), and 21-valent pneumococcal conjugate vaccine (PCV21) 2, 3, 1

For adults ≥65 years with no prior pneumococcal vaccination or unknown history, a single dose of PCV21, PCV20, or PCV15 is recommended, with a dose of PPSV23 to follow at least 1 year later if PCV15 is used 4, 5
For adults ≥65 years with prior pneumococcal vaccination, a single dose of PCV21, PCV20, or PCV15 is recommended at least 1 year after the last PPSV23 dose, or a single dose of PCV21, PCV20, or PPSV23 at least 1 year after the PCV13 dose 4
For adults with immunocompromising conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with PPSV23 to follow at least 8 weeks later if PCV15 is used 4, 5
For adults with chronic medical conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with PPSV23 to follow at least 1 year later if PCV15 is used 4, 5

For adults ≥65 years with no prior pneumococcal vaccination, a single dose of PCV21, PCV20, or PCV15 is recommended, with PPSV23 to follow at least 1 year later if PCV15 is used 4, 5
For adults ≥65 years with prior PPSV23 only, a single dose of PCV21, PCV20, or PCV15 is recommended at least 1 year after the last PPSV23 dose 4
For adults ≥65 years with prior PCV13 only, a single dose of PCV21, PCV20, or PPSV23 is recommended at least 1 year after the PCV13 dose 4

When administering PCV followed by PPSV23, the recommended interval is at least 8 weeks for immunocompromised adults and at least 1 year for immunocompetent adults 5, 4
Pneumococcal vaccines are contraindicated in persons with history of severe allergic reaction to any component of the vaccine or to any diphtheria toxoid-containing vaccine 3
Adults residing in nursing homes or long-term care facilities and those traveling to settings with no pediatric PCV program might benefit more from PCV vaccination 9

The 2024 introduction of PCV21 (CAPVAXIVE) adds another option to the pneumococcal vaccine arsenal, containing eight pneumococcal serotypes not included in previously recommended vaccines 1, 3
The 2023 ACIP recommendations simplified the approach by recommending a single dose of conjugate vaccine (PCV15, PCV20) for most adults, with PPSV23 following only in certain circumstances 5, 2