Pneumococcal disease, eligibility and current vaccine guidance
Who Should Have the Pneumococcal Vaccine?
Pneumococcal vaccination helps protect against serious infections caused by Streptococcus pneumoniae, including pneumonia, meningitis and sepsis. Eligibility depends on age, health, vaccination history and national guidance.
- Adults aged 65 and over
- Clinical-risk groups
- PCV20
- Children
- Immune suppression
- Chronic lung disease
It is not a vaccine against every pneumonia
The vaccine targets pneumococcal bacteria. Pneumonia can also be caused by other bacteria, viruses, fungi and aspiration.
UK vaccine supply changed in 2026
PCV20 is replacing PPV23 in the routine adult and clinical-risk programmes as remaining local PPV23 stocks are used.
What is the pneumococcal vaccine?
Pneumococcus can colonise the nose and throat without causing symptoms. It can also spread into the lungs, bloodstream, brain coverings or other normally sterile parts of the body.
There are many pneumococcal serotypes. Different vaccines include different combinations of the polysaccharides found on the outer capsule of selected serotypes.
“Pneumonia vaccine” is an imprecise name
Pneumococcal vaccination reduces disease caused by covered pneumococcal serotypes. It cannot prevent every case of pneumonia, because pneumonia has many other infectious and non-infectious causes.
What illnesses can pneumococcus cause?
Pneumonia
Pneumococcal pneumonia may cause cough, fever, breathlessness, chest pain and, in severe cases, respiratory failure.
Meningitis
Infection of the membranes surrounding the brain and spinal cord can cause severe neurological illness.
Bloodstream infection
Pneumococcal bacteraemia can trigger sepsis and may spread to other organs.
Pleural infection
Pneumonia may be complicated by infected fluid or pus in the pleural space, known as empyema.
Sinusitis
Pneumococcus can cause bacterial infection of the sinuses, although many sinus infections have other causes.
Middle-ear infection
Pneumococcus is an important cause of acute otitis media, particularly in younger children.
What is invasive pneumococcal disease?
Invasive pneumococcal disease means pneumococcus has been found in a normally sterile site, such as blood or cerebrospinal fluid. It includes bacteraemic pneumonia, meningitis and bloodstream infection and can be life-threatening.
What types of pneumococcal vaccine are available?
| Vaccine | Type and coverage | Current role |
|---|---|---|
| PCV13 | Conjugate vaccine covering 13 pneumococcal serotypes | Remains part of the routine UK infant programme in 2026 |
| PCV15 | Conjugate vaccine covering 15 serotypes | Used in some countries and schedules but not the routine UK national adult programme |
| PCV20 | Conjugate vaccine covering 20 serotypes | Replacing PPV23 in the UK routine adult and clinical-risk programmes during 2026 |
| PCV21 | Adult conjugate vaccine covering 21 selected serotypes | Available in the United States and some other settings; not part of the routine UK programme |
| PPV23 | Polysaccharide vaccine covering 23 serotypes | Being replaced by PCV20 in the UK as existing PPV23 stocks are used |
Conjugate and polysaccharide vaccines are different
Conjugate vaccines
In a conjugate vaccine, pneumococcal polysaccharides are linked to a carrier protein. This produces a T-cell-dependent immune response and immunological memory.
Polysaccharide vaccines
PPV23 covers more serotypes than PCV20 but produces a different immune response, with less consistent immunological memory and declining protection over time.
A higher serotype number does not automatically mean “better”
Vaccine choice also depends on immune response, duration of protection, circulating serotypes, age, clinical risk, previous vaccination and the recommendations in the relevant country.
Who should have the vaccine in the UK?
Babies
Routine childhood vaccination is currently offered at 16 weeks and again at one year of age.
Adults aged 65 and over
A routine single dose is offered from age 65, unless a suitable dose has already been received through a clinical-risk programme.
Clinical-risk groups
Eligible children and adults may need one dose, an enhanced primary schedule or regular boosters depending on the condition.
The UK programme is transitioning from PPV23 to PCV20
During 2026, providers are using remaining local PPV23 stock where appropriate and changing to PCV20 as supply becomes available. The correct vaccine at a particular appointment may therefore depend on programme implementation and local stock.
Forthcoming eligibility for people experiencing homelessness
In England, people experiencing homelessness—defined for the programme as rough sleepers and people using homeless hostels or night shelters—will become eligible from 1 October 2026.
Why is vaccination recommended from age 65?
Ageing is associated with reduced immune responsiveness and a greater likelihood of chronic heart, lung, kidney or metabolic disease. The risk of hospitalisation, invasive infection and death from pneumococcal disease therefore rises with age.
Greater infection risk
Older adults are more likely to develop severe pneumonia and invasive pneumococcal disease.
Reduced physiological reserve
Pneumonia can destabilise heart disease, diabetes, COPD, frailty and kidney function.
More serious consequences
Recovery may involve prolonged weakness, loss of independence or hospital-associated complications.
Turning 65 does not necessarily mean another dose is needed
Under current UK guidance, a person who has already received PPV23 or PCV20 because of an eligible clinical-risk condition generally does not need an additional routine PCV20 dose simply because they later reach 65.
Which medical conditions increase pneumococcal risk?
Absent or poorly functioning spleen
This includes surgical splenectomy, sickle cell disease and other causes of asplenia or splenic dysfunction.
Chronic respiratory disease
Eligible conditions include severe chronic lung disease such as COPD and cystic fibrosis, according to Green Book criteria.
Chronic heart disease
Examples include coronary heart disease, congenital heart disease and heart failure.
Chronic kidney disease
Kidney disease, nephrotic syndrome and dialysis can increase both infection risk and disease severity.
Chronic liver disease
Cirrhosis and other advanced liver conditions impair immune defence and increase severe infection risk.
Diabetes
Diabetes can impair immune responses and increase the risk of pneumonia and invasive infection.
Immune suppression
HIV, cancer, transplantation, immune disorders and immunosuppressive treatment may require vaccination.
Cerebrospinal-fluid leak
A persistent CSF leak creates a pathway through which bacteria can cause meningitis.
Cochlear implant
Cochlear implants are associated with an increased risk of pneumococcal meningitis in selected circumstances.
Welders exposed to metal fumes
Occupational exposure to metal fumes is associated with an increased risk of pneumococcal pneumonia.
Eligibility depends on the precise diagnosis
Not every mild or temporary medical problem meets the national clinical-risk definition. A GP, specialist, pharmacist or occupational-health service can check the current Green Book criteria.
Pneumococcal vaccination and chronic lung disease
COPD
Pneumonia can cause a severe COPD exacerbation, respiratory failure or prolonged functional decline.
Bronchiectasis
Structural airway damage increases vulnerability to recurrent lower-respiratory infection and exacerbations.
Cystic fibrosis
Chronic airway disease and impaired mucus clearance increase the potential impact of an acute bacterial infection.
Interstitial lung disease
Pneumonia may cause marked deterioration where lung reserve is already reduced.
Severe asthma
Eligibility depends on severity and treatment, including prolonged systemic corticosteroid exposure.
Neuromuscular respiratory weakness
Weak cough and impaired secretion clearance can increase the consequences of pneumonia.
Not everyone with asthma is automatically eligible
Mild asthma alone may not meet UK clinical-risk criteria. Eligibility is more likely where disease is severe or requires prolonged systemic corticosteroid treatment. The exact current criteria should be checked rather than assumed.
Patients with damaged airways can read more about bronchiectasis diagnosis and treatment .
Pneumococcal vaccination for immunocompromised people
Immune suppression can substantially increase the incidence and severity of invasive pneumococcal disease. It can also reduce the strength or duration of the immune response produced by vaccination.
Blood cancers
Leukaemia, lymphoma and myeloma can impair antibody and cellular immune responses.
Stem-cell transplantation
Previous immunity may be lost after transplantation, requiring a specialist revaccination programme.
Solid-organ transplantation
Immunosuppressive medicines increase susceptibility to infection and may reduce vaccine responses.
HIV
Pneumococcal-disease risk is increased, particularly with uncontrolled infection or lower CD4 counts.
Chemotherapy and immune therapies
Treatment timing can affect vaccine response and should be coordinated with the specialist team.
Long-term immunosuppressive medicine
High-dose corticosteroids, biological therapies and other treatments may place a patient in a clinical-risk group.
Older PCV13 followed by PPV23 schedules have changed
Previous guidance often recommended PCV13 followed by PPV23 for severely immunocompromised patients. The UK programme is now transitioning to PCV20-based schedules. The required number of doses depends on age, diagnosis, previous vaccines and the degree of immune suppression.
Some patients require more than one dose
Severely immunocompromised people may need an enhanced PCV20 schedule. People with asplenia, splenic dysfunction or chronic kidney disease may require booster vaccination every five years. Stem-cell transplant recipients follow specialist schedules.
The review Pneumococcal Vaccination in Immunocompromised Hosts: An Update explains the immunological and clinical rationale for prioritising these groups. Its vaccine schedules reflect guidance available in 2021 and should not replace current national recommendations.
Pneumococcal vaccination for babies and children
Routine infant vaccination
Vaccinating babies protects them directly during a period when pneumococcal disease can be particularly serious.
Community protection
Childhood conjugate vaccination also reduces carriage of covered serotypes and transmission within the population.
High-risk children
Children with severe immune suppression, asplenia, complement disorders or other risk conditions may need additional doses.
Missed childhood vaccines can often be caught up
Parents should contact their GP surgery if a routine dose has been missed. The appropriate catch-up schedule depends on the child’s current age, medical history and previous vaccinations.
How do recommendations differ internationally?
| Region | General adult approach | Important qualification |
|---|---|---|
| United Kingdom | Routine vaccination from age 65 and earlier for specified clinical-risk groups | PCV20 is replacing PPV23 during 2026 as existing PPV23 stocks are used |
| United States | Routine conjugate vaccination is recommended for adults aged 50 and over and for younger adults with selected risks | PCV20 or PCV21 generally completes vaccination; PCV15 is followed by PPSV23 |
| European countries | Age thresholds, funded vaccines and clinical-risk schedules differ substantially between countries | There is no single Europe-wide adult schedule; national guidance must be checked |
Do not transfer one country’s schedule to another
Vaccine availability, disease patterns, funding and previous childhood programmes differ. People vaccinated abroad should provide a written record so that a clinician can interpret which additional doses, if any, are appropriate.
What if you have already had a pneumococcal vaccine?
The answer depends on which vaccine was given, when it was given, your age at vaccination, your current health and whether you remain in a group requiring boosters.
Previous PPV23
A previous PPV23 dose may already satisfy routine age-based vaccination, although selected risk groups require boosters.
Previous PCV13
Some people previously received PCV13 as part of an older high-risk or overseas schedule. Further vaccination is individualised.
Previous PCV20
Most immunocompetent adults do not need PPV23 after PCV20 under current conjugate-vaccine schedules.
Unknown vaccination history
GP and immunisation records should be checked where possible. A clinician can advise when documentation cannot be found.
Asplenia or kidney disease
These groups may require vaccination every five years rather than a single lifetime dose.
Severe immune suppression
Additional primary doses or revaccination may be required under specialist guidance.
Do not repeat doses solely because you cannot remember
Ask the GP surgery, childhood immunisation service, hospital, pharmacy or occupational-health provider to check available records before arranging an additional dose.
When should vaccination be given?
Before planned immune suppression
Vaccination is preferably completed before chemotherapy, transplantation, splenectomy or major immunosuppressive treatment where timing permits.
After acute illness improves
Mild illness is not always a reason to delay, but vaccination is commonly postponed during a significant febrile illness.
Alongside other vaccines
Pneumococcal vaccine can generally be given at the same appointment as influenza and other indicated vaccines using separate injection sites.
Timing around treatment can be clinically important
Immune response may be lower during some immunosuppressive treatments. Do not delay urgent treatment, but ask the specialist team to coordinate vaccination where possible.
Safety, side effects and contraindications
Injection-site discomfort
Pain, redness, warmth or swelling around the injection site is common and usually settles within a few days.
Tiredness or headache
Temporary fatigue, headache, muscle aches or reduced appetite may occur.
Mild fever
Some people develop a short-lived raised temperature as the immune system responds.
Severe allergy
Anaphylaxis is rare but requires immediate treatment. Vaccine services are equipped to recognise and manage it.
Pregnancy and breastfeeding
The NHS advises that eligible people can usually be vaccinated during pregnancy or breastfeeding after clinical assessment.
Previous serious reaction
A severe allergic reaction to a previous dose or vaccine ingredient requires specialist advice before another dose.
Seek urgent help for signs of anaphylaxis
Call 999 for difficulty breathing, swelling of the tongue or throat, widespread hives with breathing symptoms, fainting or rapid collapse after vaccination.
How effective is pneumococcal vaccination?
Pneumococcal vaccines reduce the risk of disease caused by the serotypes they contain. Protection is not complete, and vaccine effectiveness varies with age, immune status, vaccine type, serotype and the outcome being measured.
Serotype-specific protection
Vaccines do not protect against pneumococcal serotypes that are not included in the formulation.
Reduced immune response
People receiving immune-suppressing treatment may generate less protection but can still benefit from vaccination.
Protection can change over time
Immunity may wane, especially after polysaccharide vaccination, which is why selected groups receive boosters.
Vaccination does not remove the need for medical assessment
A vaccinated person can still develop pneumococcal disease or pneumonia from another cause. Fever, breathing difficulty, confusion or chest pain still require appropriate assessment.
Frequently asked questions
Is the pneumococcal vaccine the same as the pneumonia vaccine?
It is often called the pneumonia vaccine, but it specifically protects against selected pneumococcal bacteria. It does not prevent pneumonia caused by every bacterium, virus, fungus or aspiration.
Should every UK adult have it?
No. Routine NHS vaccination is offered from age 65 and earlier to people in specified clinical or occupational-risk groups.
Which vaccine is now used in the UK?
PCV20 is replacing PPV23 in the adult and clinical-risk programmes during 2026. Remaining local PPV23 stock may still be used where appropriate during the transition.
Do I need another dose when I turn 65?
Usually not if you already received PPV23 or PCV20 because of an eligible clinical-risk condition. Your vaccination record and risk category should still be checked.
How often is the vaccine needed?
Most eligible adults require a single routine dose. People with asplenia, splenic dysfunction or chronic kidney disease may need boosters every five years. Severe immune suppression may require a different schedule.
Should people with COPD or bronchiectasis have it?
Significant chronic respiratory disease is a recognised UK risk category. Eligibility should be checked against the current Green Book definition and the individual diagnosis.
Does everyone with asthma qualify?
Not necessarily. Mild asthma alone may not qualify. Severe disease or prolonged systemic corticosteroid treatment may place a person in an eligible risk group.
Can it be given with the flu vaccine?
Yes. Pneumococcal and influenza vaccines can generally be given at the same appointment using different injection sites.
Can the vaccine cause pneumococcal infection?
No. The vaccines do not contain live pneumococcal bacteria and cannot cause pneumococcal disease.
What should I do if my vaccination history is unclear?
Ask your GP surgery, hospital, pharmacy, childhood immunisation service or occupational-health provider to check available records before arranging another dose.
Conclusion
Pneumococcal vaccination helps prevent serious infections caused by selected serotypes of Streptococcus pneumoniae. It is important not to describe it as protection against every type of pneumonia.
In the UK, vaccination is routinely offered to babies, adults aged 65 and over, and people with specified clinical or occupational risks. PCV20 is replacing PPV23 in the adult and clinical-risk programmes during 2026.
People with chronic respiratory disease, absent or poorly functioning spleens, immune suppression, chronic heart, kidney or liver disease, diabetes, CSF leaks and other listed conditions may be eligible before age 65.
Some high-risk patients require additional doses or five-yearly boosters. Previous vaccine type, timing, immune status and national guidance must therefore be reviewed before deciding on the next dose.
Patients with respiratory disease who are uncertain about their vaccination needs can discuss prevention and wider lung-health management during a specialist respiratory consultation.
References and further information
- UK Health Security Agency. Pneumococcal: the Green Book, chapter 25. View UK pneumococcal guidance
- NHS. Pneumococcal vaccine. Read NHS patient information
- UK Health Security Agency and NHS England. Change of vaccine for the routine adult pneumococcal vaccination programme and clinical-risk groups. Read the PCV20 programme letter
- UK Health Security Agency. Pneumococcal vaccination for older adults and individuals in clinical-risk groups: information for healthcare practitioners. View practitioner information
- UK Health Security Agency and NHS England. Expansion of pneumococcal-vaccine eligibility to people experiencing homelessness from 1 October 2026. Read the programme update
- Centers for Disease Control and Prevention. Pneumococcal vaccine recommendations. View current US recommendations
- European Centre for Disease Prevention and Control. Vaccine Scheduler: pneumococcal disease. Compare European schedules
- Froneman C, Kelleher P, José RJ. Pneumococcal Vaccination in Immunocompromised Hosts: An Update. Vaccines. 2021;9(6):536. Read the open-access review
- London Chest Specialist. Chest infection diagnosis and treatment. Explore the chest infection service
- London Chest Specialist. Bronchiectasis diagnosis and treatment. Read about bronchiectasis
Unsure About Your Pneumococcal Vaccination Needs?
A respiratory consultation can review your lung condition, immune status, previous vaccines, infection history and wider measures for preventing serious respiratory illness.
