Ask the Experts: Pneumococcal: Recommendations for Adults

What are the major changes in the ACIP recommendations for pneumococcal vaccination of adults since January 2022?

In January 2022, CDC published recommendations for two pneumococcal conjugate vaccines (PCV15 and PCV20) as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP stopped recommending PCV13 for adults; however, in rare circumstances if only PCV13 is accessible and the patient would otherwise be unvaccinated, CDC continues to state that PCV13 may be used. When PCV15 is used routinely, it should be used in series with PPSV23 given one year later.

In June 2024, CDC recommended PCV21 (Merck) as an option in all situations where PCV is recommended for adults. As with PCV20, PPSV23 is not recommended following PCV21.

For adults eligible for pneumococcal vaccine as a result of age or a high-risk condition who have no or unknown history of PCV, the same vaccination schedule options apply to all of them: either give one dose of PCV20 or PCV21 alone, or give a dose of PCV15 followed by a dose of PPSV23 one year later (with a minimum interval option of 8 weeks for people with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak). Since January 2022, pneumococcal recommendations are the same for all people age 19 through 64 with immunocompromising and non-immunocompromising underlying medical conditions and other risk factors for pneumococcal disease.

Details of the January 2022 recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104a1-H.pdf. These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html.

Immunize.org has developed standing orders for pneumococcal vaccination of adults that include the use of PPSV23 and all PCV options, including PCV21, at: www.immunize.org/catg.d/p3075.pdf.

• Pneumococcal
• Recommendations for Adults

What are the categories of medical conditions and other risk factors among adults for which pneumococcal vaccination is recommended? And what is the recommendation?

All people age 19 through 64 with the following medical conditions who have no history of pneumococcal vaccination or an unknown pneumococcal vaccination history should receive either a single dose of PCV20 or PCV21 alone or a dose of PCV15 followed by a dose of PPSV23 at least 1 year later. If using the PCV15 + PPSV23 series, clinicians can consider giving the dose of PPSV23 a minimum of 8 weeks later for more rapid protection against the serotypes unique to PPSV23 to people with immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leak. The conditions are:

• Alcoholism or cigarette smoking
• CSF leak
• Chronic heart disease, including congestive heart failure and cardiomyopathies, excluding hypertension
• Chronic liver disease
• Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
• Cochlear implant (including those preparing for cochlear implant)
• Diabetes mellitus
• Decreased immune function from disease or drugs (immunocompromising conditions), including:
  • Chronic renal failure or nephrotic syndrome
  • Congenital or acquired asplenia, or splenic dysfunction
  • Congenital or acquired immunodeficiency, including B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
  • Diseases or conditions treated with immunosuppressive drugs or radiation therapy, including Hodgkin disease, leukemias, lymphomas, malignant neoplasms, and solid organ transplant
  • HIV infection

  For details of vaccination following hematopoietic stem cell transplantation, see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html

  Public health authorities working with Alaska Natives and American Indians may provide additional guidance for individuals in those communities where the overall risk of invasive pneumococcal disease is increased.

  Last reviewed: August 8, 2024
  • Pneumococcal
  • Recommendations for Adults

  My patient just turned 65 and has never had a pneumococcal vaccine. What are my options now?

  For adults 65 years and older with no prior pneumococcal vaccination or whose previous vaccination history is unknown, you have two options:

  • One dose of PCV20 or PCV21 alone, or
  • One dose of PCV15 followed by a dose of PPSV23 one year later (if the patient has an immunocompromising medical condition, cochlear implant or cerebrospinal fluid leak consider giving PPSV23 as soon as 8 weeks later).
  Last reviewed: August 8, 2024
  • Pneumococcal
  • Recommendations for Adults