Objective  To examine the prevalence of 23-valent pneumococcal polysaccharide vaccine (PPV23) vaccination and its associates among elderly people aged ≥ 65 years in Changshu city for developing immunization strategies on pneumonia prevention in the elderly.

  Methods  With multi-stage random sampling, a face-to-face questionnaire survey was conducted among 2 402 elderly residents (65 to 84 years) recruited at 4 communities/towns of Changshu city during October 2021 – November 2022. The information on the participants’ PPV23 vaccination was obtained from the Jiangsu Province Comprehensive Vaccination Service Management Information System. Binary logistic regression model was used to analyze main influencing factors for PPV23 vaccination of the participants.

  Results  Among the 2 310 participants (96.17% of the elderly interviewed) with valid responses, 933 (40.39%) had PPV23 vaccination and 1 089 (47.14%) reported the willingness to have PPV23 vaccination. Logistic regression analysis showed that the elderly living far from urban central area, aged 70 – 79 years, not suffering from diabetes, and not utilizing air purifier at home or ventilation system in working place were more likely to receive PPV23 vaccination (P < 0.05 for all); while, the elderly with an average monthly income of 3 000 – 4 999 Chinese yuan, reporting poor general health, without the awareness of pneumonia vaccine, not intending or being unsure about to receive pneumonia vaccine, and washing hands more than 8 times per day with hand sanitizer or soap were less likely to have PPV23 vaccination (P < 0.05 for all).

  Conclusion  The PPV23 vaccination could be promoted among elderly people aged 65 years and above in Changshu city. The government and relevant health departments should take multiple measures from a practical perspective to implement free pneumonia vaccination for the elderly population.