Experts Share 2025 Pneumococcal Vaccination Guideline Recommendations for Children, Adolescents, and Adults

In an interview with Pharmacy Times®, Anita Siu, PharmD, BCPPS, vice chair of teaching and learning, clinical professor, and director of faculty mentoring at the Ernest Mario School of Pharmacy, Rutgers, and Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP, clinical professor at the Ernest Mario School of Pharmacy, Rutgers, explored the various types of pneumococcal vaccines (PCV15, PCV20, PCV21, and PPSV23) and their unique serotype coverages. Siu and Bridgeman discussed vaccination recommendations for different age groups, including routine childhood immunization schedules and specific guidelines for individuals with chronic conditions. The latest recommendation for adults aged 50 and older is to receive a pneumococcal vaccine, with the choice depending on individual vaccine history and accessibility. Siu and Bridgeman also emphasized the critical role of pharmacists in patient education, addressing vaccine hesitancy, and providing accurate information to help patients make informed health care decisions.

Pharmacy Times: According to the 2025 guidelines, what are the pneumococcal vaccination recommendations for adolescents and children with underlying medical conditions or risk factors?

Anita Siu, PharmD, BCPPS: That's an excellent question. First of all, I think we also need to consider how many different types of pneumococcal vaccines are available out there. We have the PCV15, and we have the PCV20. We also have the PCV21, but we also have the polysaccharide pneumococcal polysaccharide vaccine 23 (PPSV23). There are many different types, so how do they differ, and how are they similar? The serotypes differ in certain numbers that they are actually protecting against. For example, the PCV15 covers 15 serotypes—14 of them are actually contained in the PPSV23, and 1 serotype is not contained in the PPSV23, which is, for example, the 6A. There are certain variations; it doesn't mean that if you have a PCV15 or a pneumococcal conjugate vaccine 15 and then you have a pneumococcal conjugate vaccine 20, it doesn't necessarily mean it contains all the 15 in the PCV15, and you're just adding 5 more. There are different types of pneumococcal serotypes that each of them actually does cover. A key thing to note with these pneumococcal vaccines is that currently, right now, one of our newest ones, which is also known as the PCV21, is not currently approved in pediatrics. It is actually approved for 18 years and older, which is important to note. Now when we talk about risk factors, and I'll particularly discuss the children's pneumococcal risk factors, when we consider the pneumococcal vaccine, we do have the routine vaccination that we recommend. If we start off with the PCV15 and the PCV20, the first dose is given as early as 6 weeks of age, and then your routine schedule, if you follow the ACIP recommendations, is 2, 4, 6, and 12 to 15 months. Now, following that, people at least 2 years old with chronic illnesses that are not adequately effective in children younger than 2 years of age, but this is the time where we actually, with chronic illnesses, would recommend, and they have to be a minimum age of 2, the PPSV23. Then children 2 to 18 years of age may have additional pneumococcal vaccine doses based on their risk factors. These ACIP pneumococcal risk factors—there is a large list of them, but I'll just highlight a few of them. Examples are chronic heart disease, chronic kidney disease, and even chronic liver disease. Then we also consider this in certain congenital conditions when we think about children. In pediatrics, we think about congenital diseases, and certain congenital ones are congenital or acquired asplenia or splenic dysfunction and also congenital or acquired immunodeficiency. These are some examples where there are high-risk factors, where there may be subsequent pneumococcal vaccines.

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP: I would just chime in that it's also in the 18- to 49-year-old age group where we think about risk assessment or the presence of some of those underlying conditions, as you had mentioned, in determining whether a pneumococcal vaccine is indicated as well.

Pharmacy Times: What are the vaccination guidelines for individuals 65 years and older?

Bridgeman: The biggest change based on the most recent pneumococcal vaccine recommendation update is now for adults. The recommendation is that everyone aged 50 years and older should receive a pneumococcal vaccine, either the PCV15, the PCV20, or the PCV21. That depends on coverage, on accessibility, on availability, and really, based on previous pneumococcal vaccine history, on whether an individual had received a pneumococcal vaccine prior. I would say that the recommendations for which vaccine to use and the timing of pneumococcal vaccine administration are complicated and really based on an individual's history of receipt of previous pneumococcal vaccines. I usually like to use the PneumoRecs VaxAdvisor app to really help me walk through the decision tree for an individual patient when it's necessary. Again, these can be very nuanced recommendations.

Pharmacy Times: According to the 2025 guidelines, are there any specific considerations for the co-administration of pneumococcal vaccines with other routine childhood vaccines?

Siu: As far as I'm aware, for the pneumococcal vaccines in children, there is no particular guidance as to whether it's contraindicated to be co-administered with other vaccines. Currently, the recommendation is that it can be administered simultaneously with other childhood vaccines.

Pharmacy Times: Is there anything you would like to add?

Bridgeman: I would just say that as pharmacists and pharmacy immunizers, we are in a tremendous position to be able to engage in conversations related to decisions around vaccines with our patients that we serve. I frequently reflect on a quote from the former US Surgeon General that I recall, in the midst of the COVID-19 pandemic, hearing on a Sunday morning news show. This was former Surgeon General Jerome Adams, who had said it's okay to ask questions, it's okay to wonder if this is right for me, but what's not okay is to let misinformation cause you to make a decision that is bad for your health. Again, I think we are really poised to be able to engage in these questions, to engage in these types of decisions as pharmacists, to really, hopefully, be able to respectfully and politely engage and help share all of the information that we're privileged to be able to have access to with our patients.

Siu: I think I also want to comment that it is nice to work collaboratively, even though my area of expertise is in pediatrics. Working with Mary, who works with adults, a lot of our vaccine hesitancy that we mentioned earlier is very similar. It's nice to hear that we share some similarities as well, even though we may be having two different populations of age groups.