Pneumococcal (Pneumonia) Vaccine: Who Needs It and Which Type
Pneumococcal pneumonia is preventable by vaccine, yet many adults have never had one. Here is who should get it, which vaccine, and how to schedule it.
Key points
- The October 2024 ACIP update recommends a conjugate pneumococcal vaccine for all adults aged 50 and over, and for those aged 19–49 with risk conditions such as diabetes, chronic heart, lung, liver or kidney disease, smoking or HIV.
- If you have never been vaccinated, one dose of PCV20 or PCV21 is enough, or PCV15 followed by PPSV23 at least 1 year later.
- The vaccine is very safe and can be given the same day as flu, shingles or COVID vaccines; combine it with yearly flu vaccination and quitting smoking.
In my geriatric clinic I see many families whose mother or father had to be admitted to hospital with pneumonia and never quite regained their previous strength. Pneumococcal pneumonia is one of the diseases that can be prevented by vaccination, yet many Thai adults have never had the vaccine.
What is pneumococcus?
Pneumococcus (Streptococcus pneumoniae) is a bacterium that lives in the nose and throat of many people. Usually it causes no disease, but when immunity falls, for example after influenza, in older age or with chronic illness, it can spread and cause:
- Pneumonia
- Bloodstream infection (bacteremia)
- Meningitis
- Middle ear and sinus infections, which are common in children
Invasive pneumococcal disease has a high death rate in older adults, and antibiotic resistance is a growing problem, so prevention is better value than treatment.
Who should be vaccinated (current guidance)
The US Advisory Committee on Immunization Practices (ACIP) updated its recommendations in October 2024, and many countries, including doctors in Thailand, use them as a reference:
- All adults aged 50 and over (previously 65) who have not had a conjugate vaccine, or whose history is unknown
- Adults aged 19–49 with risk conditions, as listed below
Risk conditions that mean you should be vaccinated at a younger age include:
- Diabetes, heart disease, chronic lung disease including asthma, liver disease, chronic kidney disease
- Smoking, heavy drinking
- HIV infection, immune deficiency, immunosuppressive medicines, chemotherapy, organ transplant
- No spleen or a poorly functioning spleen, including some blood disorders
- A cerebrospinal fluid leak or a cochlear implant
For people living with HIV, read more in CD4 and opportunistic infections.
Age 50 and over
- Everyone not yet given a conjugate vaccine
- Or with unknown history
Age 19–49: chronic disease
- Diabetes, heart, lung, asthma
- Chronic liver or kidney disease
Age 19–49: lifestyle
- Smoking
- Heavy alcohol use
Age 19–49: immunity
- HIV, immunosuppressants, chemotherapy
- No spleen, organ transplant
Other
- Cerebrospinal fluid leak
- Cochlear implant
What types of vaccine are there?
| Type | Features |
|---|---|
| PCV13, PCV15 | Earlier conjugate vaccines covering 13 or 15 strains; stimulate good immunity with long memory |
| PCV20 | Covers 20 strains; already available in Thailand. Most adults need only one dose. |
| PCV21 | Designed for adults, covering the strains most common in adults; availability in Thailand depends on registration |
| PPSV23 | A polysaccharide vaccine covering 23 strains, but immunity doesn't last as long as with conjugate vaccines. Now used as a follow-up dose after PCV15 or PCV13. |
The vaccines available may differ between facilities; your doctor will choose the one that suits you.
How to schedule it, based on your vaccine history
Never vaccinated, or history unknown
- One dose of PCV20 or PCV21 is complete, or
- One dose of PCV15, followed by one dose of PPSV23 at least 1 year later (in people with weakened immunity, the gap can be 8 weeks)
Had PPSV23 only
- One dose of PCV20 or PCV21, at least 1 year after PPSV23
Had PCV13 (possibly with PPSV23)
- If the original plan wasn't completed, your doctor may give one dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccine, or complete the original plan with PPSV23
If you can't remember what you had, don't worry. Bring your vaccine record or hospital history for your doctor to review, or start on the plan for people with an unknown history.
Available vaccines vary by facility. Your doctor will choose what suits you.
Safety and side effects
Pneumococcal vaccines are very safe. Common side effects are pain, swelling and redness at the injection site, body aches, tiredness and a low fever for 1–2 days. Severe allergic reactions are very rare.
- It can be given on the same day as influenza, shingles or COVID vaccines, in different arms
- People who have had a severe allergic reaction to the vaccine or its components, such as diphtheria toxoid, should not receive conjugate vaccines
- If you have a high fever or an acute illness, wait until you recover
Vaccines that go with it
Protection against pneumonia works better when combined with a yearly influenza vaccine, because flu often leads to bacterial pneumonia. Adults 50+ should also consider the Shingrix shingles vaccine, and quitting smoking prevents pneumonia about as much as vaccination does. See the bigger picture of men's health at this age in Men's health after 50: what to look after.
When to see a doctor
Pneumonia in older people may not cause a high fever or an obvious cough, but may show up as drowsiness, confusion, not eating or fast breathing. Go to hospital immediately if there is fever, cough, breathlessness, chest pain when breathing, blue lips or sudden confusion. In Thailand, call 1669 for medical emergencies.
At Dr. Kris Clinic I can review your vaccine history, plan a complete set of adult vaccines for you and your parents, and give vaccines as appropriate, as part of family medicine care. English-speaking consultations are available.
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Adult vaccines at the clinic
Find out which vaccines suit your age, health conditions and travel plans.
Frequently asked questions
I'm 50 and healthy. Do I need the pneumonia vaccine?
The 2024 ACIP guidance recommends a conjugate vaccine for all adults aged 50 and over, because the risk of severe disease starts to rise from this age. Talk to your doctor to plan.
After PCV20, do I need a booster every 5 years?
Under current guidance, adults who have had one dose of PCV20 or PCV21 are complete and don't need routine boosters, unless new recommendations come out in the future.
Can I get the pneumonia vaccine together with the flu vaccine?
Yes. They can be given safely on the same day in different arms, which saves you extra visits.
I've already had pneumonia. Do I still need the vaccine?
Yes. There are many strains, and a previous infection doesn't protect you against the others.
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References
- Kobayashi M, et al. Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024. MMWR. 2025;74(1):1-8.
- Kobayashi M, et al. Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: ACIP Recommendations, 2024. MMWR. 2024;73(36):793-798.
- Centers for Disease Control and Prevention. Adult Immunization Schedule by Age, United States, 2025.
- Infectious Disease Association of Thailand. Adult and Elderly Immunization Schedule, latest edition (in Thai).
This article is for education and does not replace diagnosis or treatment by a doctor. If you have symptoms or concerns, please see a doctor.
