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Pneumococcal vaccine for older adults and people at risk - Pneumococcal vaccine for older adults and people at risk – Information for health professionals

Background

Pneumococcal disease refers to a range of infections caused by the bacterium Streptococcus pneumoniae.

These infections are classified as either non-invasive or invasive. Non-invasive forms include conditions such as sinusitis, otitis media, and bronchitis. Invasive pneumococcal disease (IPD) is more serious and includes illnesses such as pneumonia, sepsis, and meningitis. Pneumococcal meningitis is a notifiable disease.

IPD mainly affects: 

  • the very young  
  • the elderly 
  • people with no spleen or a non-functioning spleen, and  
  • people with certain chronic medical conditions and impaired immunity. 

Pneumococcal disease spreads by aerosol, respiratory droplets or through direct contact with respiratory secretions of someone carrying the organism. It has a poorly defined incubation period but may be as short as one to three days. 

The vaccine

PPV23 (Pneumovax 23®) and PCV20 (Prevenar 20®) are non-live vaccines. 

PLEASE NOTE: PCV20 is expected to replace PPV23 for adults over 65 years and the at-risk programme in early 2026. To prepare for this product change, stocks of PPV23 should be used up before ordering PCV20. 

The PCV20 pre-filled syringe and packaging looks very similar to that of PCV13. Ensure the PCV20 and PCV13 vaccines are stored separately, for example, on different fridge shelves. 

The Joint Committee on Vaccination and Immunisation (JCVI) gave advice in June 2023 that PPV23 or PCV20 could be used for the routine adult pneumococcal programme and those aged 2 years and over at clinical risk.  

The JCVI indicates that PCV20 is likely to prevent more disease than PPV23, and immunity may decline at a slower rate. 

The vaccine programme

People aged over 65 years and people aged two years and over in a clinical risk group 

PCV23 has been recommended for risk groups since 1992, and all people aged 65 years and over since 2003.  The at-risk pneumococcal vaccination programme includes people aged two years and over who fall into specific clinical risk groups. For the detailed eligibility criteria, see table 25.2 in Pneumococcal: the green book. 

There is an established association between exposure to metal fumes – particularly in welders – and increased risk of pneumococcal disease. A single dose of PPV23 or PCV20 (when available) should be considered for individuals with frequent or continuous exposure to metal fumes at work.

Babies up to 2 years of age at higher risk from pneumococcal disease 

Children under 2 years of age with asplenia, splenic dysfunction, complement disorder or severe immunocompromise should also receive PCV20 (when available). See table 25.3 in Pneumococcal: the green book – GOV.UK (external site) for further details. 

Please note: Practices should offer vaccination within 12 weeks of a person becoming eligible. The eligible age for the older adult programme is 65, which currently aligns with age eligibility for the routine shingles and flu vaccination programmes. As these vaccines can be co-administered, opportunities to co-administer where possible should be maximised. 

Dosage and administration 

Adults aged 65 years and over, and clinical risk groups aged 2 years or over: 

  • a single dose of 0.5 ml of PPV23 or PCV20 (when available) 
PPV23

PPV23 is not recommended for use in children under 2 years of age.

PPV23 should be given by intramuscular or subcutaneous injection, preferably into the deltoid muscle of the upper arm. The intramuscular route is routinely used because localised reactions are more common when vaccines are given subcutaneously. 

PCV20

PCV20 should be given by intramuscular injection, preferably into the deltoid muscle of the upper arm (in those aged one year and above).

Revaccination guidance

Individuals with asplenia, splenic dysfunction or chronic renal disease

Antibody levels are likely to decline rapidly in individuals with asplenia, splenic dysfunction or chronic renal disease. Therefore, re-immunisation with PPV23 – or PCV20 once available – is recommended every five years in these groups.

Individuals in a clinical risk group

If an individual has already received PPV23 because they are in a clinical risk group, they do not need another dose at 65 years of age, regardless of how long ago they received PPV23.

Individuals aged 65

Whilst PPV23 is being supplied for the routine programme for adults aged 65 and over, if an individual not in a risk group becomes eligible for PPV23 at age 65 but has already received PCV20, PPV23 can still be offered.

Once PCV20 has replaced PPV23, if an individual has already received PCV20 because they are in a clinical risk group, they do not require another dose at 65 years of age, regardless of how long ago they received PCV20.

Revaccination with PPV23 or PCV20 is currently not recommended for any other clinical risk groups or age groups. 

Refer to Pneumococcal: the green book for further information on the dosage and schedule. 

Summary of product characteristics (SmPC)

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. You should report suspected adverse reactions of vaccines and medicines online at Yellow Card, by downloading the Yellow Card app, or by calling 0800 731 6789 (Monday to Friday, 9am to 5pm).

New medicines and vaccines that are under additional monitoring have an inverted black triangle symbol (▼) displayed in their package leaflet and SmPC, with a short sentence explaining what the triangle means. You should report all suspected adverse reactions for these products. 

The schedule guidance in Pneumococcal: the green book supersedes the SmPC. 

The Complete Routine Immunisation Schedule includes information about routine and selective immunisation programmes and additional vaccines that may need to be considered for individuals with underlying medical conditions. 

Vaccine coadministration 

Doses of different inactivated vaccines can usually be administered at any time before, after, or at the same time as each other, unless stated otherwise. Doses of inactivated vaccines can also be given at any interval before, after, or at the same time as a live vaccine and vice versa. 

Guidance

Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.

Training resources and events

Online courses and training materials about a number of vaccines and diseases can be accessed via the E-learning page.

Further immunisation training information and resources are provided on the Training Resources and Events page.

Clinical resources and information

Patient group directions (PGDs) and protocols

PGD templates for vaccines can be found on the Patient group directions (PGDs) and protocols website.

Data and surveillance

Page last reviewed: 20th April 2026