What are the categories of medical conditions and other risk factors among adults for which pneumococcal vaccination is recommended? And what is the recommendation?

All people age 19 through 64 with the following medical conditions who have no history of pneumococcal vaccination or an unknown pneumococcal vaccination history should receive either a single dose of PCV20 alone or a dose of PCV15 followed by a dose of PPSV23 at least 1 year later. If using the PCV15 + PPSV23 series, clinicians can consider giving the dose of PPSV23 a minimum of 8 weeks later for more rapid protection against the serotypes unique to PPSV23 to people with CSF leak, cochlear implant, or immunocompromise (categories 7 through 17 below):

1. cigarette smoking (does not include people who vape)
2. alcoholism
3. chronic liver disease, including cirrhosis
4. chronic heart disease (e.g., congestive heart failure, cardiomyopathies), excluding hypertension
5. chronic lung disease (including COPD and emphysema, and asthma)
6. diabetes mellitus
7. candidate for or recipient of cochlear implant
8. cerebrospinal fluid (CSF) leak
9. functional or anatomic asplenia (e.g., splenectomy or congenital asplenia)
10. sickle cell disease and other hemoglobinopathies
11. congenital or acquired immunodeficiencies (e.g., B- [humoral] or T-lymphocyte deficiency, complement deficiencies [particularly C1, C2, C3, and C4], and phagocytic disorders [excluding chronic granulomatous disease])
12. generalized malignancy
13. HIV infection
14. Hodgkin disease, leukemia, lymphoma, and multiple myeloma
15. immunosuppression due to treatment with medication, including long-term systemic corticosteroids, and radiation therapy
16. solid organ transplantation; for bone marrow transplantation; see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
17. chronic renal failure or nephrotic syndrome

Public health authorities working with Alaska Natives and American Indians may provide additional guidance for individuals in those communities where the overall risk of invasive pneumococcal disease is increased.