Do I Need a Pneumonia Shot? Here’s Everything to Know About Pneumococcal Vaccines

Staying up to date on pneumococcal vaccinations helps keep you and those around you healthy. These vaccines lower the risk of developing pneumococcal infections such as pneumonia, sinus infections, and ear infections. But trying to figure out which pneumococcal vaccine to get and when it's recommended can be puzzling.

There’s currently five pneumococcal vaccines available in the U.S. For the most part, they differ in how many strains of pneumococcus bacteria they protect against. Which pneumococcal vaccine you may receive largely depends on your age, if you’ve received any pneumococcal vaccines in the past, and health conditions you may have.

What are the different types of pneumococcal vaccines?

There are five FDA-approved pneumococcal vaccines: 

1. Prevnar 13 (PCV13): 13-valent pneumococcal conjugate vaccine

2. Vaxneuvance (PCV15): 15-valent pneumococcal conjugate vaccine

3. Prevnar 20 (PCV20): 20-valent pneumococcal conjugate vaccine

4. Capvaxive (PCV21): 21-valent pneumococcal conjugate vaccine

5. Pneumovax 23 (PPSV23): 23-valent pneumococcal polysaccharide vaccine

Capvaxive is the newest pneumococcal vaccine. It was FDA approved in 2024. Vaxneuvance and Prevnar 20 are also relatively new, having gained approval in 2021. They joined Prevnar 13 and Pneumovax 23, which have been available for years.

Pneumococcal vaccines protect against a bacteria called Streptococcus pneumoniae, or pneumococcus for short. Although there are many viruses, bacteria, and fungi that cause pneumonia (an infection in the lungs), pneumococcus is the most common cause. Pneumococcus can also cause infections in other parts of the body.

What is pneumonia, anyway?

Pneumonia is an infection of the lung tissue that can cause shortness of breath, cough, and fever. Young children, older adults, and people with weakened immune systems are at greater risk, but anyone can get pneumonia — even those who are young and healthy. 

EXPERT PICKS: WHAT TO READ NEXT

• Lower respiratory tract infections: Find out how pneumonia, bronchiolitis, and bronchitis differ — and how to manage each of them.

• Can’t stop coughing? Learn how to tell when a cough may actually be a sign of pneumonia.

• Who should get PCV20? Discover how Prevnar 20 differs from other pneumococcal vaccines and if you’re a candidate to receive it.

Pneumococcal vaccines don’t protect against all types of pneumonia, but they protect against the most common bacterial cause.

Other types of pneumococcal disease 

Pneumonia vaccines protect against pneumococcal infections in other parts of the body as well. These infections include:

• Otitis media, an infection in the middle part of the ear

• Sinusitis (sinus infection), which is often first caused by a virus, and can develop into a bacterial infection

• Meningitis, an infection of the leptomeninges (tissue surrounding the brain and spinal cord), which can be life-threatening

• Bacteremia, a potentially life-threatening infection caused by pneumococcus in the bloodstream

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How do the pneumonia vaccines work?

Like all vaccines, pneumococcal vaccines work by showing the immune system a version of the germ that’s responsible for an infection. A pneumococcal vaccine contains part of the pneumococcus bacteria’s outer shell, made of molecules called polysaccharides. The immune system learns to recognize it, attack it, and defend the body against it — should it ever come into contact with the real bacteria in the future.

The body does this by making antibodies against the shell of the pneumococcus bacteria. These antibodies stay in your bloodstream as part of your immune system. If you’re exposed to pneumococci in the future, the antibodies recognize the bacteria’s shell and launch a targeted defense.

There are different strains of pneumococcus, though. The vaccines are made up of molecules from many of those strains.

Good to know: The pneumococcal polysaccharide vaccine (Pneumovax 23) contains polysaccharide molecules that match up with several strains of pneumococcal bacteria. Pneumococcal conjugate vaccines contain polysaccharides too, but they’re also attached to a protein. This addition of a protein allows conjugate vaccines to bring about a longer-lasting immune memory, which translates to a faster and larger immune response.

Which pneumonia vaccine is best?

There is no “best” pneumococcal vaccine. The five available pneumococcal vaccines are different, and which one is best for you depends on how old you are and whether or not you have certain medical conditions.

The main difference between the pneumococcal vaccines is the number of pneumococcus strains they protect against:

• Prevnar 13: Contains polysaccharides from 13 types of pneumococcal bacteria; it can be given to adults and children, but it has mostly been replaced in practice by Vaxneuvance, Prevnar 20, and Capvaxive

• Vaxneuvance: Contains polysaccharides from 15 types of pneumococcal bacteria and is given to adults and children

• Prevnar 20: Contains polysaccharides from 20 types of pneumococcal bacteria and is given to adults and children

• Capvaxive: Contains polysaccharides from 21 types of pneumococcal bacteria and is only given to adults

• Pneumovax 23: Contains polysaccharides from 23 types of pneumococcal bacteria and is mainly given to older adults and children with certain medical conditions

Who needs a pneumococcal vaccination?

Pneumococcal vaccinations are recommended for most children and adults — with some exceptions based on age and medical history. These recommendations come from the Advisory Committee on Immunization Practices (ACIP) and CDC.

Note: These recommendations can be hard to keep track of. Don’t worry about remembering all the details on your own. A healthcare professional can help you stay on schedule and make sure you get the right shots. You can also refer to the ACIP immunization recommendations for more information.

Children

A pneumococcal vaccination is recommended for all children under 5 years old. Which specific vaccine or vaccines children get depends on their health.

All children should receive Vaxneuvance or Prevnar 20. They need a total of four doses, staggered throughout infancy. The first three doses are given at ages 2, 4, and 6 months. The fourth dose is given between 12 and 15 months.

There’s one added layer of complexity. For children with certain medical conditions who received Vaxneuvance for their initial 4-dose series, they may need a dose of Prevnar 20 and/or Pneumovax 23 after they turn 2. These medical conditions include:

• Heart, lung, liver, or kidney disease

• Diabetes

• Cancer

• Asplenia (absence of the spleen)

• HIV

• Alcoholism 

• Sickle cell disease

• Having received an organ transplant

• Impaired immune system

• Cochlear implants (surgically implanted devices to improve hearing)

• Cerebrospinal fluid (CSF) leaks (when CSF leaks from the space around the brain and spinal cord)

Adults under age 50

Most adults age 19 to 49 don’t need a pneumococcal vaccination. This is true unless you smoke cigarettes or have certain medical conditions, such as:

• Heart, lung, or liver disease

• Diabetes

• Alcoholism

• Impaired immune system

• Chronic kidney failure

• Cancer 

• Having received an organ transplant

• Sickle cell disease

• HIV

• Asplenia

• CSF leaks

• Cochlear implants

Younger adults who do qualify for a pneumococcal vaccine should receive Vaxneuvance, Capvaxive, or Prevnar 20 if they’ve never had a pneumococcal vaccine or don’t know their vaccination history.

If you get Prevnar 20 or Capvaxive, you don’t need any additional pneumococcal vaccinations after that. But if you get Vaxneuvance, you also need to get Pneumovax 23. The two vaccines are typically given 1 year apart.

Adults age 50 and older

All adults age 50 and older should receive a pneumococcal vaccine if they've never had one or don’t know their vaccination history. Vaxneuvance, Capvaxive, or Prevnar 20 are the preferred choices.

If you get Prevnar 20 or Capvaxive, you don’t need any additional pneumococcal vaccines after that. But if you get Vaxneuvance, you’ll also need to get Pneumovax 23. These vaccines are typically given at least 1 year apart.

How often do you need to get a pneumococcal vaccination?

Sometimes, vaccines require a booster shot. This means that an additional shot is given after the initial one(s) to make sure that you don’t lose immunity over time.

In some cases, people who receive Pneumovax 23 will need a booster shot. This depends on when and why it was given. Common scenarios are as follows:

• Children who get Pneumovax 23 due to certain health conditions, such as cancer or conditions that weaken the immune system, need a booster with Pneumovax 23 or Prevnar 20 about 5 years after the first dose.

• Younger adults with a weakened immune system or other specific conditions should receive a booster with Prevnar 20 or Capvaxive if it’s been 1 year since their last dose of Pneumovax 23. This timeframe can stretch to 5 years if you’ve also received Prevnar 13 before.

• Adults over 50 who’ve only ever received Prevnar 13 or Pneumovax 23 should receive a dose of Prevnar 20 or Capvaxive. This is given at least 1 year after your Prevnar 13 or Pneumovax 23 dose.

• Adults who received Prevar 13 and Pneumovax 23 before age 65 should get a booster once they’ve turned 65 and it’s been 5 years since the dose of Pneumovax 23. The booster should be Prevnar 20 or Capvaxive.

How effective are pneumococcal vaccines?

Pneumococcal vaccines are very effective at preventing pneumonia and other pneumococcal diseases in adults and children. Getting vaccinated not only protects you from getting pneumonia and other types of pneumococcal disease, but it also protects vulnerable people around you who can’t get a shot.

For instance, prior to FDA approval, studies compared the effectiveness of Vaxneuvance and Prevnar 20 with Prevnar 13. The results showed that the new vaccines are just as effective as Prevnar 13 in triggering antibody production. They also found that the new vaccines protect against invasive disease.

Pneumovax 23 is also highly effective and protects at least 50% of healthy adults from invasive pneumococcal infections.

Are pneumococcal vaccines safe?

Yes, pneumococcal vaccines are safe. Like all vaccines, they go through rigorous scientific testing and review.

Although pneumococcal vaccines can cause mild side effects, severe reactions are rare. For instance, prior to FDA approval, experts studied Prevnar 20 and Vaxneuvance for safety. Six studies with a total of about 4,500 people looked at the safety of Prevnar 20. Across all studies, less than 2% of people reported a serious adverse event 6 months after getting Prevnar 20. This is similar to what was seen in people who got Prevnar 13.

If you have questions about whether the pneumococcal vaccines are safe for you, talk to a healthcare professional.

What are the common side effects of pneumococcal vaccines?

All pneumococcal vaccines can cause mild side effects. The pneumococcal vaccines are given in the arm and are injected into muscle. Children and adults may experience arm soreness, swelling, or redness where the shot was injected.

Other side effects that may occur in adults include:

• Fatigue

• Fever

• Chills

• Headache

• Decreased appetite

• Joint pain

• Muscle aches

Children may experience:

• Fever

• Fussiness

• Drowsiness

• Decreased appetite

The good news is that these side effects should resolve on their own within a few days.

Good to know: Prevnar 13, Vaxneuvance, and Prevnar 20 may raise the risk of febrile seizures if given to children at the same time as an annual flu shot. These seizures are caused by a high fever and occur in up to 5% of children under age 5. They can be scary but don’t cause any long-term health problems.

Where can you get a pneumococcal vaccination?

Once you decide to get vaccinated, you may wonder where to get it. These vaccinations are commonly available at medical offices and hospitals, so you might be able to get one where you see your healthcare professional. Otherwise, many pharmacies, including CVS and Walgreens locations, have the vaccines. Your local health department is also a good resource and often gives vaccinations, as well.

How much does it cost to get vaccinated?

For adults over age 65, Medicare Part B should cover the cost of pneumococcal vaccines.

If you have private insurance or Medicaid, this should also be true. Usually, routinely recommended vaccinations, like those for pneumonia, are covered by insurance companies without any copays or coinsurance. This means you can often get vaccinated at little or no cost. But make sure to check with your individual plan to confirm that the vaccines are covered.

If you need to pay out of pocket for a vaccination, you can review prices for Prevnar 13, Vaxneuvance, Prevnar 20, Capvaxive, and Pneumovax 23 with GoodRx.

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Written by:

Sarah Pozniak, MD

Sarah Pozniak, MD, has 9 years of experience since graduating medical school (6 since completing residency). She is a board-certified general internal medicine physician and has practiced as a primary care physician in both Utah and Washington, D.C. Currently, she cares for patients with chronic illnesses such as diabetes and high blood pressure using telemedicine as part of a virtual care program.

Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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