My adult patient now has a high-risk condition for which pneumococcal vaccination is recommended. He received the 7-valent pneumococcal vaccine (PCV7) in childhood, but has never had a PCV or PPSV23. What do I do?

CDC’s guidance is to ignore the remote history of PCV7 and evaluate the patient as if he has never had pneumococcal vaccination. The patient should receive either PCV20 alone or PCV15 in series with PPSV23 given at least one year later. If using PCV15, and if the high risk condition is immunocompromising or if the patient has a cochlear implant or cerebrospinal fluid leak, you may consider administering the PPSV23 as soon as 8 weeks after PCV15.