The pneumonia vaccine schedule depends on your age and health status. Infants receive a four-dose series starting at 2 months old. Most healthy adults now need a single dose at age 50 or older, following a 2024 update that lowered the threshold from 65. Adults between 19 and 49 with certain health conditions also qualify earlier.
The vaccines target pneumococcal bacteria, which cause the most common type of bacterial pneumonia along with ear infections, sinus infections, and meningitis. Several vaccine options are available, each covering a different number of bacterial strains.
Vaccine Types Available Now
Four pneumococcal vaccines are currently used in the United States. Three are conjugate vaccines, which tend to produce a stronger, longer-lasting immune response: PCV15 (covering 15 bacterial strains), PCV20 (20 strains), and PCV21 (21 strains). The fourth, PPSV23, is a polysaccharide vaccine covering 23 strains. It works differently and is typically used as a follow-up dose rather than a standalone option.
For most people, the choice comes down to PCV20 or PCV21 as a single shot, or PCV15 followed later by a dose of PPSV23. Your provider can help determine which route makes sense, but the simplest path for most adults is a single dose of PCV20 or PCV21.
Schedule for Infants and Young Children
Babies receive either PCV15 or PCV20 in a four-dose series at these ages:
- 2 months
- 4 months
- 6 months
- 12 through 15 months
If your child missed doses or started the series late, catch-up vaccination is recommended for all children under 5. The number of catch-up doses and the spacing between them depend on how old the child is when they begin. Your pediatrician can map out the adjusted timeline.
Schedule for Adults 50 and Older
In October 2024, the Advisory Committee on Immunization Practices expanded its recommendation so that all adults 50 and older (not just those 65 and up) should receive a pneumococcal conjugate vaccine if they have never had one. Previously, healthy adults under 65 only qualified if they had specific risk factors.
If you have never received any pneumococcal conjugate vaccine, you have two options:
- Option A: A single dose of PCV20 or PCV21. Nothing else needed.
- Option B: One dose of PCV15, followed by one dose of PPSV23 at least one year later.
If you already received the older PCV13 vaccine at some point, plus a dose of PPSV23 at age 65 or later, you can choose whether to get an additional dose of PCV20 or PCV21. This is a shared decision with your provider, not a blanket recommendation.
Schedule for Adults 19 to 49 With Risk Factors
Adults younger than 50 qualify for pneumococcal vaccination if they have conditions that raise their risk of serious pneumococcal disease. These include chronic heart disease, chronic lung disease, diabetes, liver disease, alcoholism, and cigarette smoking, among others. The same two-option approach applies: a single dose of PCV20 or PCV21, or PCV15 followed by PPSV23 at least a year later.
People with conditions that weaken the immune system, cochlear implants, or cerebrospinal fluid leaks follow a tighter timeline. Instead of waiting a full year between PCV15 and PPSV23, they can receive the second dose as soon as 8 weeks after the first. The shortened interval reflects the higher urgency of building protection quickly.
How Long Protection Lasts
Immunity from pneumococcal vaccines does not last forever. Antibody levels rise after vaccination, then gradually decline. In older adults, antibody levels measured 4 to 7 years after a polysaccharide vaccine tend to drop back toward pre-vaccination levels. A CDC modeling study estimated that vaccine effectiveness against invasive pneumococcal disease in healthy 65-year-olds was about 75% in the first five years, 37% over the next five, and roughly 18% in the five years after that before dropping to zero.
That said, one large observational study found effectiveness of 71% five to eight years out and 80% at nine or more years, so real-world protection varies. Conjugate vaccines generally produce more durable immune memory than polysaccharide vaccines, which is one reason the newer conjugate options are now preferred as the primary dose.
Revaccination with a polysaccharide vaccine given five or more years after an initial dose has been shown to boost antibody levels significantly and is well tolerated in older adults. Earlier revaccination (within a few years) was historically associated with more local reactions at the injection site, but doses spaced at least five years apart do not carry that concern.
Common Side Effects
Most side effects are mild and resolve within a day or two. The most frequently reported reactions include soreness or swelling at the injection site, fatigue, headache, mild fever, and decreased appetite. Some people feel drowsy afterward. Infants may experience the same effects, along with fussiness and temporary changes in eating patterns.
Severe allergic reactions are rare. One safety review found that the vast majority of adverse events reported after pneumococcal vaccination were minor. If you notice hives, facial swelling, or difficulty breathing after any vaccination, that requires emergency medical attention.
One specific note for parents: children who receive the pneumococcal conjugate vaccine and a flu shot at the same visit have a slightly higher risk of febrile seizures. These seizures, while frightening, are generally brief and do not cause lasting harm. If this concerns you, spacing the two vaccines a few days apart is a reasonable option to discuss with your child’s doctor.