Pneumococcal Vaccination Recommendations for Adults Under 50 Years of Age

Risk-Based Recommendations for Adults Under 50

• The Centers for Disease Control and Prevention recommends pneumococcal vaccination for adults aged 19-49 years with chronic medical conditions, such as chronic cardiovascular disease, chronic pulmonary disease, diabetes mellitus, alcoholism, and chronic liver disease, due to increased risk of pneumococcal disease 1, 2
• The Centers for Disease Control and Prevention recommends pneumococcal vaccination for adults aged 19-49 years with immunocompromising conditions, such as functional or anatomic asplenia, HIV infection, and other immunocompromising conditions or medications, due to increased risk of pneumococcal disease 1, 3, 4
• The Centers for Disease Control and Prevention recommends pneumococcal vaccination for special populations, including Native Americans and Alaska Natives, residents of long-term care facilities, and current smokers, due to increased risk of pneumococcal disease 2, 3, 5

Vaccine Selection for Adults Under 50 Years with Risk Factors

• The Centers for Disease Control and Prevention recommends administering a single dose of PCV20 (20-valent pneumococcal conjugate vaccine) to adults aged 19-49 years with risk factors, as the preferred option 4, 6
• The Centers for Disease Control and Prevention recommends administering a single dose of PCV15 (15-valent pneumococcal conjugate vaccine), followed by a dose of PPSV23 (23-valent pneumococcal polysaccharide vaccine) at least 1 year later, as an alternative option 4, 6

Special Considerations

• The Centers for Disease Control and Prevention recommends that adults who have previously received PPSV23 only should receive a single dose of PCV20 or PCV15 at least 1 year after the last PPSV23 dose 6
• The Centers for Disease Control and Prevention recommends that adults who have previously received PCV13 only should receive a single dose of PCV20 or PPSV23 after at least 1 year interval 6

Clinical Evidence and Rationale

• The recommendation for risk-based vaccination in adults under 50 years is supported by evidence showing that certain medical conditions significantly increase the risk of invasive pneumococcal disease and pneumonia, with a strength of evidence considered high 1, 4, 7
• The newer conjugate vaccines (PCV15, PCV20) have demonstrated good immunogenicity in adults aged 18-49 years with and without risk factors, with a strength of evidence considered high 4, 6, 7