Pneumococcal Vaccination in Adults

Full update March 2022

Use this algorithm to select the recommended pneumococcal vaccine (including timing of doses) in patients who should be vaccinated. For additional guidance, download the CDC’s PneumoRecs VaxADvisor Mobile App ( Note at the time of publication the newer vaccines are recommended as one-time doses (i.e., no recommendations for repeat doses of Prevnar 20 or Vaneuvance).1

Pneumococcal Vaccination Flow Chart

  1. Immunocompromising conditions include:1 chronic kidney failure, congenital or acquired immunodeficiencies (includes B- or T- cell deficiency, complement deficiencies, and phagocytic disorders [excluding chronic granulomatous disease]), generalized malignancy, HIV infection, Hodgkin disease, iatrogenic immunosuppression (diseases requiring treatment with systemic corticosteroids [14 days or longer2], other immunosuppressive drugs [e.g., chemotherapy], radiotherapy), leukemia, lymphoma, multiple myeloma, nephrotic syndrome, congenital or acquired asplenia; hemoglobinopathies (including sickle cell disease) and solid organ transplant.
  2. Conditions increasing pneumococcal disease risk:1 alcoholism; chronic liver disease, heart disease (including heart failure or cardiomyopathy), or lung disease (including COPD, emphysema, or asthma); cochlear implant; CSF leak; diabetes; and smoking.
  3. If Vaxneuvance is given to a patient naive to all pneumococcal vaccines, a dose of Pneumovax 23 is recommended one year after Vaxneuvance (for patients with conditions that increase pneumococcal risk) or ≥8 weeks after Vaxneuvance (for patients with immunocompromising conditions, cochlear implant, or CSF leak).1
  4. Prevnar 20 or Vaxneuvance should be given ≥1 year after the last Pneumovax 23 dose. Patients given Vaxneuvance do NOT need a follow-up Pneumovax 23 dose.1
  5. AFTER a dose of Prevnar 13, give Pneumovax 23 ≥8 weeks later (≥1 year later for immunocompetent adults ≥65 years old who chose to receive Prevnar 13 based on shared decision making).Patients between 19 and 64 years old who are eligible for pneumococcal vaccine due to being immunocompromised should receive a second Pneumovax 23 dose ≥5 years after their first dose and ≥8 weeks after Prevnar 13. Patients who received ≥1 dose of Pneumovax 23 before age 65 should receive another Pneumovax 23 dose at age 65 or older ≥5 years after their previous Pneumovax 23 dose. Can substitute Prevnar 20 if Pneumovax 23 is NOT available.1


  1. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Jan 28;71(4):109-117.
  2. CDC. Vaccine recommendations and guidelines of the ACIP: altered immunocompetence. February 15, 2022. (Accessed February 24, 2022).
  3. Kobayashi M, Bennett NM, Gierke R, et al. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015 Sep 4;64(34):944-7. [Erratum: MMWR Morb Mortal Wkly Rep. 2015 Oct 30;64(42):1204.]

Cite this document as follows: Clinical Resource, Pneumococcal Vaccination in Adults. Pharmacist’s Letter/Prescriber’s Letter. March 2022. [380301]

Related Articles