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 49 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 or PCV21 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 immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leak. The conditions are:

• Alcoholism or cigarette smoking
• CSF leak
• Chronic heart disease, including congestive heart failure and cardiomyopathies, excluding hypertension
• Chronic liver disease
• Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
• Cochlear implant (including those preparing for cochlear implant)
• Diabetes mellitus
• Decreased immune function from disease or drugs (immunocompromising conditions), including:
  • Chronic renal failure or nephrotic syndrome
  • Congenital or acquired 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)
  • Diseases or conditions treated with immunosuppressive drugs or radiation therapy, including Hodgkin disease, leukemias, lymphomas, malignant neoplasms, and solid organ transplant
  • HIV infection

For details of vaccination following hematopoietic stem cell transplantation, see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html

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.