The first pneumonia vaccine you should receive is a pneumococcal conjugate vaccine, specifically PCV15, PCV20, or PCV21. Which one you choose determines whether you need a second shot. PCV20 and PCV21 are one-and-done options. PCV15 requires a follow-up dose of PPSV23 about a year later.
The Three First-Dose Options
All three conjugate vaccines work the same way: they train your immune system to recognize the bacteria that cause pneumococcal disease, including pneumonia, bloodstream infections, and meningitis. The difference is how many bacterial strains each one covers.
- PCV15 covers 15 strains. Because it covers fewer strains on its own, it needs to be followed by PPSV23 (which covers 23 strains) to round out your protection.
- PCV20 covers 20 strains and completes your pneumococcal vaccination in a single shot.
- PCV21 covers 21 strains and is also a single-shot option. This is the newest vaccine, added to CDC recommendations in early 2025.
If simplicity matters to you, PCV20 or PCV21 is the easier path. One visit, no follow-up dose needed, and your pneumococcal vaccinations are complete.
If You Get PCV15 First
Choosing PCV15 means you’ll need a second appointment for PPSV23. The standard interval is one year between doses. For people with weakened immune systems, a cochlear implant, or a cerebrospinal fluid leak, that gap can be shortened to a minimum of eight weeks.
PPSV23 is a different type of vaccine (a polysaccharide vaccine rather than a conjugate vaccine) and covers 23 strains. The combination of PCV15 followed by PPSV23 gives you broad coverage comparable to getting PCV20 or PCV21 alone.
Who Needs a Pneumonia Vaccine
CDC recommends a pneumococcal conjugate vaccine for all adults 50 and older who have never received one. Adults 19 through 49 qualify if they have certain health conditions, including diabetes, chronic heart disease (not just high blood pressure), chronic lung disease like COPD or asthma, chronic kidney disease, chronic liver disease, a weakened immune system, or a cochlear implant.
For adults 65 and older, the recommendation is slightly more flexible. You have the option to receive PCV20 or PCV21, or to skip additional pneumococcal vaccines altogether if you’ve already been vaccinated. This shared decision is best made based on your own vaccination history.
If You Already Got an Older Vaccine
Many adults received PCV13 or PPSV23 years ago, and the rules for updating your protection depend on what you’ve already had.
If you only received PPSV23 in the past, you should get a conjugate vaccine (PCV15, PCV20, or PCV21) at least one year after your last PPSV23 dose. If you choose PCV15 in this situation, you do not need another PPSV23.
If you received only PCV13, you’re recommended to get PCV20 or PCV21 at least one year after that PCV13 dose. Alternatively, you can get PPSV23 to complete the older two-dose series.
If you already completed a full series of both PCV13 and PPSV23, the picture depends on your age when you received PPSV23. Adults 65 and older who got PPSV23 at 65 or later may still choose to get PCV20 or PCV21, but it’s not a strong recommendation. It’s a conversation to have based on your individual risk. If your PPSV23 was given before age 65, one dose of PCV20 or PCV21 is recommended at least five years after your last pneumococcal vaccine.
Cost and Coverage
Medicare Part B covers pneumococcal vaccines and their administration with no out-of-pocket cost when your provider accepts Medicare assignment. Coverage was updated in June 2024 to align with the latest ACIP recommendations, so the newer vaccines like PCV20 and PCV21 are included. Most private insurance plans also cover recommended adult vaccines at no cost under the Affordable Care Act’s preventive care provisions.
What to Expect After the Shot
All pneumococcal vaccines are given as a single injection in the upper arm. The most common reactions are soreness at the injection site, mild fatigue, and muscle aches, typically lasting a day or two. These reactions are not a reason to avoid future doses.
You should not receive any pneumococcal conjugate vaccine if you’ve had a severe allergic reaction to a previous dose or to any vaccine containing diphtheria toxoid. For PPSV23, the contraindication is a severe allergic reaction to a prior dose or any component. If you’re moderately or severely ill at the time of your appointment, it’s reasonable to wait until you’ve recovered before getting vaccinated.