Pneumococcal vaccination in Belgian adults: a practical translation of the 2025 Superior Health Council guidelines

BACKGROUND: Pneumococcal disease remains a significant burden in Belgian adults, with 2,120 cases of invasive pneumococcal disease (IPD) reported in 2024, the highest in a decade. Despite clear indications, vaccination uptake remains unacceptably low (13-24% in risk groups). Complex sequential vaccination schedules involving pneumococcal conjugate vaccines followed by the 23-valent polysaccharide vaccine (PPV23), combined with limited awareness among healthcare providers and the public, and incomplete reimbursement policies, have contributed to implementation barriers and poor adherence. METHODS: This review provides a practice-oriented translation of the 2025 Superior Health Council of Belgium guidelines on adult pneumococcal vaccination. We analysed Belgian National Reference Centre 2024 serotype surveillance data to support age-stratified vaccine selection recommendations. KEY RECOMMENDATIONS: A single-dose conjugate vaccine approach now replaces all prior sequential regimens. Vaccine selection is age-stratified based on Belgian serotype epidemiology: PCV20 for adults 18-49 years with risk conditions (serotype 4 coverage critical); PCV20 or PCV21 for ages 50-84 years; and PCV21 preferred for adults ≥ 85 years (15% coverage advantage). PPV23 is eliminated from routine recommendations. Co-administration with influenza, RSV, and COVID-19 vaccines is supported, enabling maximal respiratory protection in a single visit. CONCLUSION: One conjugate vaccine dose, selected by age, provides maximal pneumococcal protection. The challenge is implementation to increase vaccination coverage: every clinical encounter with an at-risk adult is a vaccination opportunity.