Pneumococcal vaccine selection for adults 19 to 64 years of age

Conjugate vaccine history	No prior PCV or PCV7		Received PCV10 or PCV13		Received PCV15		PCV20
PPSV23 vaccine history	No PPSV23	Received PPSV23	No PPSV23	Received PPSV23	No PPSV23	Received PPSV23
Healthy	No vaccination needed	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable
Chronic conditions^*	Give PCV20^¶	Give PCV20^Δ ≥1 year after PPSV23 dose	Give PCV20^◊ ≥1 year after PCV10/13 dose	The ACIP does not recommend further vaccination at this time Our authors prefer to give PCV20^◊ ≥5 years after last pneumococcal vaccine dose to impart immunity against additional serotypes	Give PPSV23 ≥1 year after PCV15 dose^§	No further vaccination^§	No further vaccination
Immunocompromised (except for HCT recipients)^¥	Give PCV20^‡ Our authors also prefer to give PPSV23 ≥8 weeks following PCV20 to provide immunity against more serotypes^§	Give PCV20^† ≥1 year after PPSV23 dose^§	Give PCV20^** ≥1 year after PCV10/13 dose Our authors also prefer to give PPSV23 ≥8 weeks following PCV20 to impart immunity against additional serotypes^§	Give PCV20^** ≥5 years after last pneumococcal vaccine dose^§	Give PPSV23 ≥1 year after PCV15 dose^§	Give PPSV23 ≥5 years after last PPSV23 dose^§	Our authors also prefer to give PPSV23 ≥8 weeks following PCV20 to provide immunity against more serotypes^§
Increased risk for meningitis (eg, CSF leak, cochlear implant)		Give PCV20^† ≥1 year after PPSV23 dose^§			Give PPSV23 ≥1 year after PCV15 dose^§	Give PPSV23 ≥5 years after last PPSV23 dose^§

The ACIP updated its pneumococcal vaccine recommendations in 2022 and 2023. This table provides guidance to clinicians on vaccine selection for their adult patients aged 19 to 64 years based on the patients' previous pneumococcal vaccination history. In some situations, the recommendations of our UpToDate authors differ slightly from that of the ACIP. Refer to the UpToDate text on pneumococcal vaccination in adults for additional information. Clinicians should review guidelines for pneumococcal vaccination in patients ≥65 years of age once their patient turns 65 years old.

ACIP: United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices; CSF: cerebrospinal fluid; HCT: hematopoietic cell transplant; PCV7: 7-valent pneumococcal conjugate vaccine; PCV10: 10-valent pneumococcal conjugate vaccine; PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PCV20: 20-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.

* Chronic conditions include alcohol abuse disorder, chronic heart disease, including congestive heart failure and cardiomyopathies, chronic liver disease; chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma, cigarette smoking, and diabetes mellitus.

¶ If PCV20 is not available, PCV15 followed by PPSV23 ≥1 year later is a recommended alternative. If PPSV23 is administered, our UpToDate authors continue to revaccinate with PPSV23 every 5 to 10 years.

Δ If PCV20 is not available, PCV15 is a recommended alternative. If PCV15 is administered, our UpToDate authors continue to revaccinate with PPSV23 every 5 to 10 years.

◊ If PCV20 is not available, give PPSV23 ≥1 year after last PCV10/13 dose and ≥5 years after last PPSV23 (if applicable). If PPSV23 is administered, our UpToDate authors continue to revaccinate with PPSV23 every 5 to 10 years.

§ Our UpToDate authors continue to administer PPSV23 every 5 to 10 years as they believe the benefit of revaccination outweighs the minimal risks. Refer to the UpToDate text on pneumococcal vaccination in adults for additional information on the ACIP and authors' recommendations.

¥ Immunocompromised patients include those with chronic renal failure, congenital or acquired asplenia, congenital or acquired immunodeficiency (including B-[humoral] or T-lymphocyte deficiency, complement deficiencies [particularly C1, C2, C3, and C4 deficiencies], and phagocytic disorders [excluding chronic granulomatous disease]), generalized malignancy, HIV infection, Hodgkin disease, iatrogenic immunosuppression (including disease requiring treatment with immunosuppressive drugs such as long-term systemic corticosteroids and radiation therapy), leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease or other hemoglobinopathies, and solid organ transplant. HCT recipients are excluded from this category because they have different recommendations for pneumococcal vaccination post hematopoietic cell transplant. Refer to the UpToDate text on immunizations in HCT recipients for additional information.

‡ If PCV20 is not available, PCV15 followed by PPSV23 ≥8 weeks later is a recommended alternative. Our UpToDate authors continue to revaccinate with PPSV23 every 5 to 10 years.

† If PCV20 is not available, PCV15 is a recommended alternative.

** If PCV20 is not available, give PPvSV23 ≥8 weeks after last PCV10/13 dose and ≥5 years after last PPSV23 (if applicable). The ACIP recommends a total of two PPSV23 vaccine doses (≥5 years apart) for immunocompromised patients. Our UpToDate authors continue to revaccinate with PPSV23 every 5 to 10 years.

Adapted from: Kobayashi M, Pilishvili T, Farrar JL, et al. Pneumococcal vaccine for adults aged ≥19 years: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2023; 72:1.

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Pneumococcal vaccine selection for adults 19 to 64 years of age