In certain limited circumstances, adults with immunocompromising conditions have an option for vaccination that includes multiple doses of PPSV23. Under the 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) may complete the immunization schedule with either PCV20 or PPSV23:
- Option 1: Administer one dose of PCV20 at least one year after the dose of PCV13. No additional doses of pneumococcal vaccine are recommended.
- Option 2: Administer a dose of PPSV23 at least 8 weeks after the PCV13. Those who are still younger than age 65 at least 5 years after the dose of PPSV23 may receive a second dose of PPSV23 or a dose of PCV20 at that time. If two doses of PPSV23 are given, plan to review the pneumococcal vaccination recommendations again once this person turns 65.
Last reviewed:
April 5, 2024
That is not necessary. CDC has stated that either PCV20 or PPSV23 may be used in this circumstance. If PCV20 is used, no further pneumococcal vaccine doses are indicated.
Last reviewed:
April 5, 2024
At this time, ACIP does not recommend revaccination with a second dose of PPSV23 for adults younger than 65 with asplenia who receive PCV15 (Vaxneuvance, Merck) followed by PPSV23.
If the adult patient with asplenia had received PCV13 (Prevnar 13, Pfizer) followed by PPSV23 (instead of Vaxneuvance), then CDC recommends one of two vaccine schedules:
- Option 1: Administer a dose of PCV20 at least 5 years after the dose of PPSV23. No further doses of pneumococcal vaccine are recommended.
- Option 2: Administer PPSV23 at least 5 years following the first PPSV23 dose. Plan to review CDC recommendations for pneumococcal vaccination at the time the patient turns 65 because additional doses might be recommended at that point.
Last reviewed:
April 5, 2024
Either a second PPSV23 or a dose of PCV20 should be given 5 years after the first dose of PPSV23 for people age 19 through 64 years who were vaccinated with PCV13 (Prevnar 13, Pfizer) and PPSV23 and who have one of the following immunocompromising conditions:
- Kidney disease and on maintenance dialysis
- Kidney disease with nephrotic syndrome
- Asplenia or splenic dysfunction
- Congenital or acquired immunodeficiency, including B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
- Treatment with immunosuppressive drugs or radiation therapy (including treatment for Hodgkin disease, leukemias, lymphomas, malignant neoplasm, and solid organ transplant)
- HIV infection
- Sickle cell disease or other hemoglobinopathies
Last reviewed:
April 5, 2024
Perhaps. CDC recommends two options for people age 65 or older who have immunocompromising conditions, a cochlear implant, or a cerebrospinal fluid (CSF) leak and received PCV13 and either one or two doses of PPSV23 before age 65:
- Option 1: Give a dose of PCV20 at least 5 years after the last pneumococcal vaccine dose
- Option 2: Give a dose of PPSV23 at least 8 weeks after PCV13 and at least 5 years after the previous PPSV23 dose
A patient age 65 or older who received one or two doses of PPSV23 before age 65 but has not received any PCV product, or their history of PCV vaccination is unknown, is recommended to receive a single dose of either PCV15 or PCV20 at least one year after the last dose of PPSV23.
Last reviewed:
April 5, 2024
No. ACIP does not recommend revaccination with PPSV23 for any adult who has received a dose of PPSV23 after turning 65. However, this patient should receive a dose of either PCV15 or PCV20 now.
Last reviewed:
April 5, 2024
