Now that we have PCV20 and PCV15, is any adult still recommended to receive multiple doses of PPSV23?

Yes. Under the new ACIP recommendations published in January 2022, adults age 19 through 64 who have already received a dose of PCV13 (as previously recommended for those with immunocompromising conditions [including asplenia], CSF leak, or cochlear implant) should complete the immunization schedule that was recommended before the introduction of PCV15 and PCV20.

Adults age 19 through 64 who have immunocompromising conditions, a CSF leak, or a cochlear implant and who have already received a dose of PCV13 should receive a dose of PPSV23 at least 8 weeks later. Those who are immunocompromised should then receive a second dose of PPSV23 at least 5 years following the first dose; if younger than 65 at the time of dose 2, they should receive a third dose of PPSV23 at least 5 years later and after turning 65.

If PPSV23 is unavailable when vaccination is due and PCV20 is available, PCV20 may be used. If PCV20 is administered, no additional doses of pneumococcal vaccine are recommended.