Does a patient who was vaccinated with PCV13 and one or two doses of PPSV23 before age 65 still need an additional dose of PPSV23 at age 65 or later?

They need a dose of PCV20 or PCV21, but not another dose of PPSV23. CDC recommends that people age 50 or older who received PCV13 and either one or two doses of PPSV23 before age 65 should receive a dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccine dose. If they received PCV15 followed by PPSV23, they are not recommended to receive any additional pneumococcal vaccine doses at this time.  

A patient age 50 or older who received one or two doses of PPSV23 earlier in life but has not received any PCV product, or their history of PCV vaccination is only PCV7 or unknown, is recommended to receive a single dose of a currently recommended pneumococcal conjugate vaccine (PCV15, PCV20, or PCV21) at least one year after the last dose of PPSV23.