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Adult Pneumococcal Disease Prevention

CE / CME

Elucidating the Rapid Changes in Pneumococcal Disease Prevention in Adults

Pharmacists: 0.50 contact hour (0.05 CEUs)

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: June 09, 2026

Expiration: June 08, 2027

Richard Colgan
Richard Colgan, MD
CME/CE Information

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Pneumococcal Vaccine Options and Safety

Pneumococcal vaccine options can generally be divided into 2 categories: pneumococcal conjugate vaccines (PCVs) and the pneumococcal polysaccharide vaccine (PPSV23).12,13

The conjugate vaccines include PCV15, PCV20, and PCV21. PCV15 is recommended as part of a 2-vaccine series with PPSV23 or 1 of the PCVs, whereas PCV20 and PCV21 are single-dose options. PCV21 was specifically designed to target serotypes that commonly affect adults.13

The pneumococcal polysaccharide vaccine, PPSV23, is another effective option when used as part of a series with PCV15.12

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Serotypes Targeted by Pneumococcal Vaccines

The primary difference between all the available pneumococcal vaccines, and the reason there are so many currently available, is that each vaccine targets different serotypes of Streptococcus pneumoniae.

Earlier vaccines were developed using older epidemiologic data and targeted the serotypes most prevalent at that time. As surveillance data have evolved, we now recognize additional serotypes that contribute to IPD, including strains associated with antimicrobial resistance. The newer vaccines were developed to address these changing disease patterns.14

The specifics of what serotypes are covered by each vaccine are complex and difficult to memorize, but these tables can be used as clinical reference tools during patient care.14

The key takeaway is that each vaccine targets a broad range of serotypes, and the latest vaccine, PCV21, includes 8 unique serotypes not covered by the others. PCV21 was introduced in 2024 and was specifically designed to address serotypes commonly associated with adult IPD.14

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Expanded Age-Based Indication for Pneumococcal Vaccination

Recently, the CDC expanded its age-based indication for pneumococcal vaccination. The rationale behind this comes from analysis of Active Bacterial Core surveillance data between 2018-2019.

These data demonstrated crucial differences in incidence of IPD between Black and non-Black adults. Among Black adults, IPD rates peaked at a younger age, approximately 55-59 years, whereas rates among non-Black adults increased progressively with advancing age.15

These findings suggest that expanded age-based indications for pneumococcal vaccination may improve health equity and potentially reduce disparities in disease burden.

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Vaccination Recommendations for Adults ≥50 Years

Updated CDC recommendations advise that all adults 50 years of age or older should receive pneumococcal vaccination.16

For adults who have not previously received pneumococcal vaccination, options include PCV15 followed by PPSV23 at least 1 year later, or administration of either PCV20 or PCV21 as a single dose.16

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Vaccination Recommendations for Adults 19-49 Years With Risk Factors

Pneumococcal vaccination is also recommended for adults at younger ages (19-49 years of age) if they have certain risk factors for severe pneumococcal disease.16

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Pneumococcal Vaccine Schedule: Age ≥50 Years

Although the pneumococcal vaccine recommendations for previously unvaccinated adults 50 years of age or older are relatively straightforward, the complexity and nuance of vaccine selection come into play for people who have prior pneumococcal vaccine history.17

Although a number of variables are involved in this decision-making, the key consideration is determining which pneumococcal vaccines the patient has previously received. Based on prior vaccination history, you may select among several recommended options, including PCV20, PCV21, or PCV15 followed by PPSV23.17

For example, if a patient previously received PCV13 at any age and PPSV23 before age 65, they should receive PCV20 or PCV21 at least 5 years later. If a patient received PCV13 at any age and PPSV23 at or after age 65, the CDC recommends shared decision-making regarding administration of PCV20 or PCV21 at least 5 years later.17

Because of the complexity of these recommendations, these schedules are best approached using CDC reference tables or digital guidance tools rather than memorization alone. I recommend using the CDC PneumoRecs VaxAdvisor tool in clinical practice.17

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Years With Immunocompromising Condition, Cochlear Implant, or CSF Leak

For adults 19-49 years of age with immunocompromising conditions, cochlear implants, or CSF leaks, vaccination recommendations also depend on prior pneumococcal vaccination history.17

You should first determine which vaccines the patient has already received before selecting the appropriate schedule.

For example, if a patient previously received PCV13 at any age, they should receive PCV20 or PCV21 at least 1 year later.17

If a patient previously received PCV15, they should receive PPSV23 at least 8 weeks later. Usually, this interval would be at least 1 year, but it may be accelerated depending on the individual’s risk category and immune status.17

These recommendations include multiple pathways and timing intervals, reinforcing the importance of using CDC guidance tables or electronic reference tools during patient care.17

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Pneumococcal Vaccine Schedule: Age 19-49 Years With Chronic Disease

Likewise, for adults aged 19-49 years with chronic disease, vaccination recommendations depend on both the patient’s underlying condition and prior pneumococcal vaccination history.17

Once you determine which vaccines the patient has already received, you may select among the recommended pathways outlined in CDC guidance. As with other patient groups, PCV20 or PCV21 administered at least 1 year later is a commonly recommended option for patients who previously received PPSV23 or PCV13.17

In this population, patients who previously received PCV15 followed by PPSV23, PCV20, or PCV21 may need no additional vaccination. However, once the patient reaches 50 years of age, the need for further vaccination should be reassessed.17

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Updated Recommendations for PPSV23 in Adults

Another important consideration for vaccine selection is that PPSV23 should be used only in combination with PCV15 in adults. Appropriate timing depends on the patient’s immune status and prior vaccination history.16

PPSV23 is no longer recommended for patients previously vaccinated with PCV13 who have not completed the prior vaccine series. Current recommendations instead favor administration of PCV20 or PCV21.16

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Updated Recommendations for Serotype 4 in Adults

However, one scenario where recommendations differ is when serotype 4 is prevalent.

Serotype 4 is responsible for ≥30% of IPD in certain settings, including among members of the Navajo Nation and in Alaska, Colorado, New Mexico, and Oregon.16

Serotype 4 disease is also more common among individuals with alcohol use disorder, chronic lung disease, cigarette smoking, housing insecurity, and injection drug use.16

In these populations with high incidence of serotype 4 IPD, PCV20 is preferred, because serotype 4 is not included in PCV21. PCV15 followed by PPSV23 may also be considered.16

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