Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the Centers for Disease Control and Prevention.

Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years

Centers for Disease Control and Prevention

Publication Date: Jan 9, 2025

Page Last Updated: May 5, 2026

Table. Clinical guidance for implementing pneumococcal vaccine recommendations for adults aged ≥19 years — United States, October 2024

Risk or age group	Vaccine received previously	Options for vaccination
Adults aged ≥50 years	None or PCV7 only at any age	A single dose of PCV21, PCV20, or PCV15. If PCV15 is administered, a single dose of PPSV23* should be administered ≥1 year after the PCV15 dose. A minimum interval of 8 weeks can be considered if PCV15 is used in adults with an immunocompromising condition,† cochlear implant, or CSF leak.
	PPSV23 only	A single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose.
	PCV13 only	A single dose of PCV21 or PCV20 ≥1 year after the PCV13 dose.
	PCV13 at any age and PPSV23 at age <65 years	A single dose of PCV21 or PCV20 ≥5 years after the last pneumococcal vaccine dose.
	PCV13 at any age and PPSV23 at age ≥65 years	Shared clinical decision-making is recommended regarding administration of either a single dose of PCV21 or PCV20 for any adult aged ≥65 years who has completed the recommended vaccination series with both PCV13 and PPSV23 (i.e., PPSV23 administered at age ≥65 years) but PCV21, PCV20, or PCV15 not yet received. If a decision to administer PCV21 or PCV20 is made, a single dose is recommended ≥5 years after the last pneumococcal vaccine dose.
Adults aged 19–49 years with an immunocompromising condition,† a CSF leak, or a cochlear implant	None or PCV7 only at any age	A single dose of PCV21, PCV20, or PCV15. If PCV15 is used, administer a single dose of PPSV23* ≥8 weeks after the PCV15 dose.
	PPSV23 only	A single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose.
	PCV13 only	A single dose of PCV21 or PCV20 administered ≥1 year after the PCV13 dose.
	PCV13 and 1 dose of PPSV23	A single dose of PCV21 or PCV20 ≥5 years after the last pneumococcal vaccine dose. The pneumococcal vaccination series is complete, and it need not be followed by additional pneumococcal vaccine doses.
	PCV13 and 2 doses of PPSV23	The pneumococcal vaccination recommendations should be reviewed again when the person turns age 50 years. Alternatively, a single dose of either PCV21 or PCV20 should be administered ≥5 years after the last pneumococcal vaccine dose. If PCV21 or PCV20 is used, the series is complete, and it need not be followed by additional pneumococcal vaccine doses.
Adults aged 19–49 years with chronic medical conditions§	None or PCV7 only at any age	A single dose of PCV21, PCV20, or PCV15. If PCV15 is administered, a single dose of PPSV23* should be administered ≥1 year after the PCV15 dose.
	PPSV23 only	A single dose of PCV21, PCV20, or PCV15 ≥1 year after the last PPSV23 dose.
	PCV13 only	A single dose of PCV21 or PCV20 ≥1 year after the PCV13 dose.
	PCV13 and 1 dose of PPSV23	The pneumococcal vaccination recommendations should be reviewed again when the person reaches age 50 years.

Abbreviations: CSF = cerebrospinal fluid; PCV = pneumococcal conjugate vaccine; PCV7 = 7-valent PCV; PCV13 = 13-valent PCV; PCV15 = 15-valent PCV; PCV20 = 20-valent PCV; PCV21 = 21-valent PCV; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.
* For adults who have received PCV15 but have not completed their recommended pneumococcal vaccine series with PPSV23, 1 dose of PCV21 or PCV20 may be used if PPSV23 is not available.
† Chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, HIV infection, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplant, congenital or acquired asplenia, or sickle cell disease or other hemoglobinopathies.
§ Alcoholism; chronic heart disease, including congestive heart failure and cardiomyopathies; chronic liver disease; chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma; cigarette smoking; or diabetes mellitus.

Document Overview

Document Title: Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years

Authoring Society: Centers for Disease Control and Prevention

Document Publication Date: Jan 9, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.cdc.gov/mmwr/volumes/74/wr/mm7401a1.htm

Source Citation: Kobayashi M, Leidner AJ, Gierke R, et al. Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep 2025;74:1–8. DOI: http://dx.doi.org/10.15585/mmwr.mm7401a1.

Document Scope, Criteria, and Use Cases

Document Objectives: Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19–64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals) or 21-valent PCV (PCV21; CAPVAXIVE; Merck Sharp & Dohme) alone or 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23; Merck Sharp & Dohme). There are additional recommendations for use of PCV20 or PCV21 for adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13; Prevnar13; Wyeth Pharmaceuticals). The ACIP Pneumococcal Vaccines Work Group employed the Evidence to Recommendations framework to guide its deliberations on expanding the age-based PCV recommendation to include adults aged 50–64 years. On October 23, 2024, ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years. Recommendations for PCVs among adults aged 19–49 years with risk conditions and PCV13-vaccinated adults have not changed from previous recommendations. This report summarizes evidence considered for these recommendations and provides updated clinical guidance for use of PCV.

Scope: Management, Prevention

Diseases/Conditions (MeSH)

D022242 - Pneumococcal Vaccines

Keywords: Pneumococcal Conjugate, Pneumococcal vaccine

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years

Summary of Recommendations

Recommendations for Use of PCV

Selection of PCV in Populations with High Proportions of Serotype 4 Pneumococcal Disease

PPSV23 Use in PCV13-Experienced Adults Who Have Not Completed the Recommended Vaccination Series

Coadministration with Other Vaccines

Contraindications and Precautions

Figure. Serotypes*,† included in pneumococcal vaccines currently recommended for adults — United States, 2024

Table. Clinical guidance for implementing pneumococcal vaccine recommendations for adults aged ≥19 years — United States, October 2024

Box. Clinical guidance on selection of pneumococcal conjugate vaccine in communities with high percentages of serotype 4 pneumococcal disease — United States, 2024

Document Overview

Document Scope, Criteria, and Use Cases