Indications for PCV13 and PPSV23 for at-risk adultsa

Risk groupPCV13PPSV23PPSV23 revaccination 5 years after first dose
At-risk patients ages 19 to 64 with comorbid conditions
Immunocompetent persons with chronic heart disease,b chronic lung disease,c diabetes mellitus, alcoholism, chronic liver disease, cirrhosis, or cigarette smokingNoYesNo
Persons with cerebrospinal fluid leak or cochlear implantsYesYesNo
Immunocompromised and asplenic patients
Persons with functional or anatomic asplenia (sickle cell disease, other hemoglobinopathy, or congenital or acquired asplenia)YesYesYes
Immunocompromised persons, ie, with congenital or acquired immunodeficiency,d human immunodeficiency virus infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression,e solid organ transplant, or multiple myelomaYesYesYes
  • PCV13 = pneumococcal conjugate vaccine-13; PPSV23 = pneumococcal polysaccharide vaccine-23

  • a All adults age 65 and older should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine.

  • b Including congestive heart failure and cardiomyopathies, excluding hypertension.

  • c Including chronic obstructive pulmonary disease, emphysema, and asthma.

  • d Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease).

  • e Diseases requiring treatment with immunosuppressive therapy, including long-term systemic corticosteroids and radiation therapy.

  • Adapted from US Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816–819.