San Francisco Marin Medical Society Blog

Vax Facts: Pneumococcal Vaccines in Adults Age 65 Years and Older

Vax Facts - January 13, 2020

Pneumococcal Vaccines in Adults Age > 65 Years

Background: In 2014 the CDC Advisory Committee on Immunization Practices (ACIP) recommended 13-valent pneumococcal conjugate vaccine (Prevnar13®) in series with 23-valent pneumococcal polysaccharide vaccine (Pneumovax23®) for all adults age > 65 years.

In 2019 ACIP reviewed evidence that: (a) among persons age > 65 years, indirect effects of routine Prevnar13 use in children since 2010 have led to historically low levels of disease caused by the 13 pneumococcal serotypes in the vaccine; and (b) those disease levels have not been significantly improved by routine Prevnar13 use in persons age > 65 years since 2014.

Recommendation: ACIP now recommends the following.

  • Prevnar13 vaccination is no longer routinely recommended for all adults age > 65 years.
  • •Patients age > 65 years who have an immunocompromising condition, CSF leak, or cochlear implant should still routinely receive Prevnar13 if they have not previously received it.
  • For all others age > 65 years, patient and provider should engage in shared clinical decision-making to determine whether Prevnar13 should be administered. Considerations may include both the individual patient’s risk for developing pneumococcal disease as a result of underlying medical conditions and the person’s risk for exposure to PCV13 serotypes.
  • •Prevnar13 and Pneumovax23 should not be given concomitantly due to potential interference with development of immunity. The recommended intervals between Prevnar13 and Pneumovax23 doses have not changed.


ACIP guidance:

CDPH Infographic on Timing of Pneumococcal Vaccines:

CDC PneumoRecs Phone App:

Program Contact Information:

Communicable Disease Prevention Unit
Disease Prevention and Control Branch, Population Health Division
Tel: (415) 554 – 2955 / Fax: (415) 554 – 2579
Email: /

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