Is there any situation when an adult at high risk of invasive pneumococcal disease should receive more than one dose of PPSV23?

Based on changes to the ACIP recommendations made in October 2024, a second dose of PPSV23 is no longer recommended for any adult. Adults age 19 through 49 years with immunocompromising conditions who received a dose of PCV15 followed by a dose of PPSV23 have received a complete pneumococcal vaccine schedule, and no further doses are recommended. If they received PCV13 and PPSV23, instead of PCV15, CDC recommends a dose of PCV20 or PCV21 should be given 5 years after the first dose of PPSV23, if the patient has 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