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Pneumococcal Disease Prevention FAQ
Expert Answers to FAQ on Contemporary Pneumococcal Disease Prevention

Released: November 06, 2025

Paul G. Auwaerter
Paul G. Auwaerter, MD, MBA
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Key Takeaways
  • PCV can be given in combination with other vaccines, and coadministration is a crucial strategy for increasing overall vaccine uptake.
  • Patients are often hesitant to receive multiple vaccines at a time due to fear of side effects. Healthcare professionals should reassure them that most side effects are localized, transient, and mild, and that the risk for severe side effects is vastly outweighed by the benefits of vaccination, especially for people with risk factors for severe pneumococcal disease.

In this commentary, Paul G. Auwaerter, MD, answers audience questions from a MEDX Primary Care symposium on contemporary pneumococcal disease prevention.

Can the pneumococcal vaccine (PCV) be given with other vaccines, and have they been studied together?
Paul G. Auwaerter, MD:
In general, even if vaccines have not been rigorously studied in combination, it is well known that you can give 2 or even 3 vaccines simultaneously, without impairing immune responses to those vaccines.

I always say that when opportunity strikes, healthcare professionals (HCPs) should try to administer as many vaccines as the patient is willing to accept. However, if vaccines must be administered separately, it should be with a minimum of 2 weeks separation.

What are some common challenges you encounter with getting patients to take multiple vaccines at a time, and how do you address these challenges?
Paul G. Auwaerter, MD:
Many patients are worried about injection-site pain with multiple vaccines. I like to remind them that the side effects don’t tend to be synergistic. They tend to be localized and minor, and they are easily treatable with acetaminophen or ibuprofen, if necessary.

I usually tell patients, unless they really need their arms for a sporting activity or something similar, why not just get all their vaccines out of the way? I remind them that it’s more convenient to get all their vaccines now, while they are already here, rather than making the time to come back.

I have learned that people have the best intentions to come back, or at least they say they will, but life often gets in the way. When they leave without receiving all their vaccines, I find that I just lost the chance to immunize them.

Another common concern is the potential for serious side effects. To address this, I tell patients that there have not really been any documented severe side effects with pneumococcal vaccines, with any frequency. Now, one can imagine a theoretical risk of anaphylaxis, but that is not a major cause for concern unless there is a known allergic reaction to a component of the vaccine. I think people are sometimes afraid of Guillain-Barré syndrome, which can be a very rare side effect of influenza immunization. However, Guillain-Barré syndrome is very rare, and the benefits of receiving any vaccine outweigh the small risk.

What is the role of the polysaccharide 23-valent vaccine?
Paul G. Auwaerter, MD:
I would say, in adults, there probably is no role for that vaccine anymore. The 21- or 20-valent conjugate vaccines really have replaced the 23-valent vaccine.

One of the few situations in which it might still be used is in combination with the PCV15 vaccine, for adults who received a dose of PCV7 at any age. However, just from a logistical standpoint, it is simpler to use the 2 most recently FDA-approved vaccines.

I also want to emphasize that if you are unsure of the current recommendations, the CDC PneumoRecs VaxAdvisor App is a great resource. For example, young adults sometimes have health problems that would qualify them for a PCV, or they may have missed some vaccines as a child. Specific cases can quickly get complicated if the patient has risk factors or is unsure if they have gotten all their vaccines. The CDC pneumococcal vaccine advisor is very helpful for assessing if patients should get a follow-up vaccine.

To encourage vaccine uptake, do you change your messaging for patients with risk factors for severe pneumococcal disease vs patients without?
Paul G. Auwaerter, MD:
Yes, because I think many people are unaware of how much they could be at risk of invasive pneumococcal disease. That is where it really comes to the fore. For example, people who have splenic conditions could be faced with overwhelming sepsis, and people with cochlear implants are at increased risk for meningitis or cerebrospinal fluid leaks. People with chronic liver disease or chronic kidney disease on dialysis are also more prone to develop complications of pneumonia or invasive pneumococcal disease.

The patients I really worry about are those who have multiple myeloma or other conditions that could cause problems generating antibodies. These conditions may also affect vaccine efficacy, but still, I think HCPs should try to provide every bit of protection for those people who are at the highest risk for invasive pneumococcal disease.

In all, I find there is very little resistance to PCV if HCPs recommend it. It does not quite seem to elicit the same resistance that people have to the flu vaccine, the COVID vaccine, or even the shingles vaccine. I find PCV is usually an easier sell if you talk about life-threatening sepsis, because people understand that.

Your Thoughts
What’s your experience with recommending PCV to your eligible patients? What other questions do you have regarding PCV vaccines? Leave a comment to join the discussion!

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