Pneumococcal Vaccine Timing for Adults

Make sure your patients are up to date with pneumococcal vaccination.

Two pneumococcal vaccines are recommended for adults:

 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar13

)

 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax

23)

PCV13 and PPSV23

should not be

administered during the

same ofﬁce visit.

When both are

indicated, PCV13

should be given

before PPSV23

whenever possible.

If either vaccine is

inadvertently given

earlier than the

recommended window,

do not repeat the dose.

One dose of PCV13 is recommended for adults:

 65 years or older who have not previously received PCV13.

 19 years or older with certain medical conditions and who have not

previously received PCV13. See Table 1 for speciﬁc guidance.

One dose of PPSV23 is recommended for adults:

 65 years or older, regardless of previous history of vaccination with

pneumococcal vaccines.

– Once a dose of PPSV23 is given at age 65 years or older, no

additional doses of PPSV23 should be administered.

 19 through 64 years with certain medical conditions.

– A second dose may be indicated depending on the medical

condition. See Table 1 for speciﬁc guidance.

Pneumococcal vaccine timing for adults 65 years or older

For those who have not received any pneumococcal

vaccines, or those with unknown vaccination history

PCV13

(at ≥ 65 years)

At least 1 year apart for most

immunocompetent adults

At least 8 weeks apart for adults

with certain medical conditions

PPSV23

(at ≥ 65 years)

 Administer 1 dose of PCV13.

 Administer 1 dose of PPSV23 at least 1 year later for most

immunocompetent adults or at least 8 weeks later for adults

with immunocompromising conditions, cerebrospinal uid leaks,

or cochlear implants. See Table 1 for speciﬁc guidance.

For those who have previously received 1 dose of PPSV23

at ≥65years and no doses of PCV13

PPSV23

(at ≥ 65 years)

At least 1 year apart

for all adults

PCV13

(at ≥ 65 years)

 Administer 1 dose of PCV13 at least 1 year after the dose of

PPSV23 for all adults, regardless of medical conditions.

www.cdc.gov/pneumococcal/vaccination.html

NCIRDig410 | 11.30.2015

U.S. Department of

Health and Human Services

Centers for Disease

Control and Prevention

Pneumococcal vaccine timing for adults with certain medical conditions

Indicated to receive 1dose of PPSV23 at 19through 64years

PPSV23

(at 19–64 years)

At least 1 year apart

PCV13

(at ≥ 65 years)

At least 1 year apart

PPSV23

(at ≥ 65 years)

At least 5 years apart

Includes adults with:

 chronic heart or lung disease

 diabetes mellitus

 alcoholism

 chronic liver disease

Also includes adults who smoke cigarettes

For those who have not received any pneumococcal vaccines, or

those with unknown vaccination history:

 Administer 1 dose of PPSV23 at 19 through 64 years.

 Administer 1 dose of PCV13 at 65 years or older. This dose

should be given at least 1 year after PPSV23.

 Administer 1 nal dose of PPSV23 at 65 years or older. This

dose should be given at least 1 year after PCV13 and at

least 5 years after the most recent dose of PPSV23.

Indicated to receive 1dose of PCV13 at ≥ 19years and 1 or 2doses of PPSV23 at 19through 64years

PCV13

(at 19–64 years)

At least 8 weeks apart

PPSV23

(at 19–64 years)

At least 5 years apart

PPSV23

(at 19–64 years)

At least 5 years apart

PPSV23

(at ≥ 65 years)

Includes adults with:

 cerebrospinal uid (CSF) leaks*

 cochlear implants*

 sickle cell disease or other

hemoglobinopathies

 congenital or acquired asplenia

 congenital or acquired

immunodeciencies

 HIV infection

 chronic renal failure

 nephrotic syndrome

 leukemia

 lymphoma

 Hodgkin disease

 generalized malignancy

 iatrogenic immunosuppression

 solid organ transplant

 multiple myeloma

For those who have not received any pneumococcal vaccines, or

those with unknown vaccination history:

 Administer 1 dose of PCV13.

 Administer 1 dose of PPSV23 at least 8 weeks later.

 Administer a second dose of PPSV23 at least 5 years after

the previous dose (*note: a second dose is not indicated for

those with CSF leaks or cochlear implants).

 Administer 1 nal dose of PPSV23 at 65 years or older.

This dose should be given at least 5 years after the most

recent dose of PPSV23.

NCIRDig410 | 11.30.2015 Pneumococcal Vaccine Timing for Adults | Page 2 Centers for Disease Control and Prevention

Table 1. Medical conditions or other indications for administration of PCV13 and PPSV23 for adults

Medical indication Underlying medical

condition

PCV13 for ≥ 19 years PPSV23* for 19 through 64 years PCV13 at ≥ 65 years PPSV23 at ≥ 65 years

Recommended Recommended Revaccination Recommended Recommended

None None of the below



≥ 1 year after PCV13

Immunocompetent

persons

Alcoholism

 



≥ 1 year after PCV13

≥ 5 years after any

PPSV23 at < 65 years

Chronic heart disease

†

Chronic liver disease

Chronic lung disease

Cigarette smoking

Diabetes mellitus

Cochlear implants



≥ 8 weeks

after PCV13



If no previous

PCV13 vaccination



≥ 8 weeks after PCV13

≥ 5 years after any

PPSV23 at < 65 years

CSF leaks

Persons with

functional or anatomic

asplenia

Congenital or acquired

asplenia



≥ 8 weeks

after PCV13



≥ 5 years after

rst dose PPSV23



If no previous

PCV13 vaccination



≥ 8 weeks after PCV13

≥ 5 years after any

PPSV23 at < 65 years

Sickle cell disease/other

hemoglobinopathies

Immunocompromised

persons

Chronic renal failure



≥ 8 weeks

after PCV13



≥ 5 years after

rst dose PPSV23



If no previous

PCV13 vaccination



≥ 8 weeks after PCV13

≥ 5 years after any

PPSV23 at < 65 years

Congenital or acquired

immunodeciencies

Generalized malignancy

HIV infection

Hodgkin disease

Iatrogenic

immunosuppression

‡

Leukemia

Lymphoma

Multiple myeloma

Nephrotic syndrome

Solid organ transplant

* This PPSV23 column only refers to adults 19 through 64 years of age. All adults 65 years of age or

older should receive one dose of PPSV23 5 or more years after any prior dose of PPSV23, regardless of

previous history of vaccination with pneumococcal vaccine. No additional doses of PPSV23 should be

administered following the dose administered at 65 years of age or older.

†

Including congestive heart failure and cardiomyopathies

Including chronic obstructive pulmonary disease, emphysema, and asthma

Includes B- (humoral) or T-lymphocyte deciency, complement deciencies (particularly C1, C2, C3, and

C4 deciencies), and phagocytic disorders (excluding chronic granulomatous disease)

‡

Diseases requiring treatment with immunosuppressive drugs, including long-term systemic

corticosteroids and radiation therapy

NCIRDig410 | 11.30.2015 Pneumococcal Vaccine Timing for Adults | Page 3 Centers for Disease Control and Prevention

Additional scenarios: completing the pneumococcal vaccination

series for adults

Adults recommended to receive PCV13 at ≥19years who already received 1dose of PPSV23 at <65years

PPSV23

(at < 65 years)

At least 1 year apart

PCV13

(at < 65 years)

At least 8 weeks apart

PPSV23

(at < 65 years)

At least 5 years apart

PPSV23

(at ≥ 65 years)

At least 5 years apart

Adults recommended to receive PCV13 at ≥19years who already received

2doses of PPSV23 at <65years and 1dose of PPSV23 at ≥65years

PPSV23

(at < 65 years)

PPSV23

(at < 65 years)

PPSV23

(at ≥ 65 years)

At least 1 year apart

PCV13

(at ≥ 65 years)

Adults recommended to receive PCV13 at ≥19years who already received

2doses of PPSV23 and 1dose of PCV13 at <65years

PPSV23

(at < 65 years)

PPSV23

(at < 65 years)

PCV13

(at < 65 years)

At least 8 weeks apart

PPSV23

(at ≥ 65 years)

At least 5 years apart

Adults recommended to receive PCV13 at ≥19 years who already received

2doses of PPSV23 at <65years and 1dose of PCV13 at ≥65years

PPSV23

(at < 65 years)

PPSV23

(at < 65 years)

PCV13

(at ≥ 65 years)

At least 8 weeks apart

PPSV23

(at ≥ 65 years)

At least 5 years apart

 For those who have already received 1

or more doses of PPSV23, or those with

unclear documentation of the type of

pneumococcal vaccine received:

– Administer 1 dose of PCV13 at

least 1year after the most recent

pneumococcal vaccine dose.

– Administer a second dose of PPSV23

at least 8 weeks after PCV13 and

at least 5 years after the previous

dose of PPSV23 (note: a second

dose is not indicated for those with

CSF leaks or cochlear implants).

– Administer 1 nal dose of PPSV23 at

65years or older. This dose should

be given at least 5 years after the

most recent dose of PPSV23.

 For those who have already received 1 dose

of PCV13, do not administer an additional

dose at 65 years or older.

NCIRDig410 | 11.30.2015 Pneumococcal Vaccine Timing for Adults | Page 4 Centers for Disease Control and Prevention