Pneumococcal bacteria commonly cause serious infections, including pneumonia, meningitis, and bacteremia (a bloodstream infection). These diseases, collectively called pneumococcal disease, pose a significantly heightened risk for adults aged 65 and older. Due to this increased vulnerability and the evolution of the bacteria, public health authorities have updated prevention recommendations. New vaccine options are now available for seniors, offering more robust protection against circulating strains.
The Latest Pneumococcal Vaccines for Seniors
Two newer pneumococcal conjugate vaccines (PCVs) are now recommended for adults: PCV15 and PCV20. These vaccines replace the previously recommended PCV13 and broaden protection against various serotypes, or strains, of the bacteria. The number in the vaccine name indicates how many different serotypes the vaccine protects against.
PCV20 (Prevnar 20) protects against 20 pneumococcal serotypes. It offers a complete, single-shot immunization series for most adults who have not been vaccinated before. PCV15 (Vaxneuvance) covers 15 serotypes, including all those from the older PCV13, plus two additional types.
Using PCV15 requires a follow-up dose of the pneumococcal polysaccharide vaccine (PPSV23), also known as Pneumovax 23. PPSV23 protects against 23 serotypes, including several not covered by PCV15, ensuring the broadest possible coverage. The choice between the single-shot PCV20 or the two-shot series (PCV15 followed by PPSV23) is a matter of clinical preference and patient discussion.
Determining Eligibility: Who Should Get Vaccinated?
The primary group for these updated recommendations is all adults aged 65 years and older. Any person in this age group who has not previously received a pneumococcal conjugate vaccine, or whose history is unknown, should receive one of the new vaccine options. These age-based recommendations exist because the immune system naturally becomes less effective with age.
Younger adults aged 19 to 64 also qualify if they have certain underlying medical conditions or risk factors. This includes chronic conditions such as heart, lung, liver, or kidney disease, or diabetes. Other qualifying conditions include alcoholism, cerebrospinal fluid (CSF) leaks, cochlear implants, or any condition that compromises the immune system. The increased risk from these health issues makes vaccination important, even if the individual is under 65.
Sequencing: What If I Have Been Vaccinated Before?
The process of receiving the new vaccines is more complex for individuals who have already been vaccinated with older products.
Never Vaccinated
If a person has never received any pneumococcal vaccine, they should receive a single dose of PCV20, or a dose of PCV15 followed by a dose of PPSV23. When using the two-shot PCV15-PPSV23 series, the PPSV23 dose should be given at least one year after the PCV15 dose. A minimum interval of eight weeks may be considered for those with severely immunocompromising conditions.
Previously Received Only PPSV23
For seniors who previously received only the PPSV23 vaccine, the current recommendation is a single dose of either PCV20 or PCV15. This newer conjugate vaccine must be administered at least one year after the last PPSV23 dose. If the patient receives PCV15 in this scenario, their vaccination series is considered complete, and they do not need an additional PPSV23 dose.
Previously Received Only PCV13
Individuals who previously received only the PCV13 vaccine should receive a single dose of PCV20 at least one year after their PCV13 shot to complete their protection. An alternative option is to receive one dose of PPSV23 instead of PCV20, with the interval being at least one year, or a minimum of eight weeks for those who are immunocompromised.
Completed PCV13 and PPSV23 Series
Adults aged 65 or older who have already completed the series with both PCV13 and PPSV23 may discuss receiving an additional dose of PCV20 with their healthcare provider, provided at least five years have passed since their last shot.