TABLE 1. Recommendations for use of 15-valent pneumococcal conjugate vaccine in series with 23-valent pneumococcal polysaccharide vaccine or 20-valent pneumococcal conjugate vaccine in pneumococcal conjugate vaccine-naïve adults aged ≥19 years — United States, 2022.

Medical indication group	Specific underlying medical condition	Age group, yrs
		19–64	≥65
None	None	None	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later*
Underlying medical conditions or other risk factors	Alcoholism	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later§	1 dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 years later*
	Chronic heart disease†
	Chronic liver disease
	Chronic lung disease¶
	Cigarette smoking
	Diabetes mellitus
	Cochlear implant
	CSF leak
	Congenital or acquired asplenia
	Sickle cell disease or other hemoglobinopathies
	Chronic renal failure**
	Congenital or acquired immunodeficiencies**,††
	Generalized malignancy**
	HIV infection**
	Hodgkin disease**
	Iatrogenic immunosuppression**,§§
	Leukemia**
	Lymphoma**
	Multiple myeloma**
	Nephrotic syndrome**
	Solid organ transplant**

Abbreviations: CSF = cerebrospinal fluid; PCV15 =15-valent pneumococcal conjugate vaccine; PCV20 = 20-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

* Adults with immunocompromising conditions, cochlear implant, or CSF leak might benefit from shorter intervals such as ≥8 weeks. These vaccine doses do not need to be repeated if given before age 65 years.

^† Includes congestive heart failure and cardiomyopathies.

^§ Adults with immunocompromising conditions, cochlear implant, or CSF leak might benefit from shorter intervals such as ≥8 weeks.

^¶ Includes chronic obstructive pulmonary disease, emphysema, and asthma.

** Indicates immunocompromising conditions.

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

^§§ Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.