Who Should Get the Pneumonia Vaccine — and Which One?

Why is pneumococcal disease taken seriously?

Streptococcus pneumoniae — the bacterium the vaccine protects against — causes not only pneumonia but also bacterial meningitis, sepsis (bloodstream infection), and severe ear and sinus infections. Older adults and people with weakened immune systems or certain chronic conditions face a higher risk of serious complications and death from these infections 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis. The vaccines significantly reduce that risk, which is why vaccination is especially important for people at highest risk.

Who is recommended to get the pneumococcal vaccine?

Adults 65 and older. All adults in this age group are recommended to receive a pneumococcal vaccine. Current ACIP guidance recommends either one dose of PCV20 alone, or one dose of PCV15 followed by a dose of PPSV23 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis2Ref 2Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022).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.Specific vaccine formulations (PCV15, PCV20, PPSV23) and which combination applies to adults by prior vaccination history and age; guidance for those with prior PCV13 or PPSV23. If you received an older vaccine (such as PCV13 or PPSV23) before age 65, your clinician will determine whether an additional dose is needed based on what you received and when 2Ref 2Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022).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.Specific vaccine formulations (PCV15, PCV20, PPSV23) and which combination applies to adults by prior vaccination history and age; guidance for those with prior PCV13 or PPSV23.

Adults under 65 with elevated risk. Several groups of younger adults are also recommended to vaccinate because their risk of serious disease is elevated:

• Chronic conditions: diabetes, chronic heart disease, chronic lung disease (including COPD), chronic liver disease, or chronic kidney disease
• People who smoke cigarettes 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis
• Immune-compromising conditions: HIV, certain cancers, or immunosuppressive medications
• People without a functioning spleen (such as those who have had a splenectomy or have sickle cell disease) — this group is at very high risk of severe pneumococcal infection 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis
• Residents of nursing homes or long-term care facilities
• People with cerebrospinal fluid (CSF) leaks or cochlear implants

If any of these apply to you and you are under 65, ask your clinician whether you should be vaccinated now 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis2Ref 2Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022).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.Specific vaccine formulations (PCV15, PCV20, PPSV23) and which combination applies to adults by prior vaccination history and age; guidance for those with prior PCV13 or PPSV23.

Children. Pneumococcal vaccines are part of the routine childhood schedule, with a series beginning in early infancy 3Ref 3Issa AN, Wodi AP, Moser CA, Cineas S (2025).Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2025.Pneumococcal vaccines are part of the routine childhood immunization schedule, with a series beginning in early infancy. Questions about a child's schedule are best directed to a pediatrician.

Which pneumococcal vaccine do I need — PCV15, PCV20, or PPSV23?

This is where a conversation with your clinician or pharmacist matters. The pneumococcal vaccine landscape currently includes PCV15, PCV20, and PPSV23 — each covering a different number of bacterial strains. The recommendation on which one to use, and how many doses, depends on your age, underlying health conditions, and what you have previously received 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis2Ref 2Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022).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.Specific vaccine formulations (PCV15, PCV20, PPSV23) and which combination applies to adults by prior vaccination history and age; guidance for those with prior PCV13 or PPSV23.

• Someone who has already received PCV20 likely needs nothing more.
• Someone who received only PPSV23 may still benefit from a conjugate vaccine.
• Someone who has never received any pneumococcal vaccine has multiple recommended paths.

Guidance in this area has evolved as newer vaccines have become available, and it may continue to change. Always confirm with your clinician or pharmacist what is currently indicated for you 2Ref 2Kobayashi M, Farrar JL, Gierke R, Leidner AJ, Campos M, Tiwari TSP, Marlow M, Wodi AP, Patel M (2022).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.Specific vaccine formulations (PCV15, PCV20, PPSV23) and which combination applies to adults by prior vaccination history and age; guidance for those with prior PCV13 or PPSV23.

How does smoking affect my risk and vaccine eligibility?

Smoking damages the lungs' natural defenses against respiratory infections, increasing susceptibility to pneumococcal disease. Smokers under 65 are included in the groups recommended for vaccination 1Ref 1Kobayashi M, Pilishvili T, Farrar JL, et al. (2023).Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023.Who qualifies for pneumococcal vaccination including adults 65+, smokers, people without a spleen, and high-risk younger adults with chronic conditions; seriousness of pneumococcal disease including meningitis and sepsis. Quitting smoking also meaningfully reduces risk over time, and your clinician can connect you with evidence-based cessation support.