OBJECTIVES: Adults with immunocompromising conditions have higher chances of developing pneumococcal disease and should receive pneumococcal vaccination based on the recommendations by U.S. Centers for Disease Control and Prevention. This study examined pneumococcal vaccination in immunocompromised adults, including patients with chronic renal disease (CRD), cancer, HIV infection, and patients who underwent transplant. METHODS: A large administrative claims database was used to assess the pneumococcal vaccination among adults aged 19-64 years who were newly diagnosed with CRD, cancer, HIV, or patients underwent organ transplant procedure during 2007-2010. These patients were followed until 2011 or the end of enrollment to identify whether they received pneumococcal vaccination after the diagnosis or procedure. Multivariate logistic regression was used to examine patients characteristics associated with pneumococcal vaccination coverage. RESULTS: We identified 22,862 patients with CRD, 216,658 with cancer, 2,576 with HIV infection, and 41,889 patients underwent transplant procedure during the study period. The pneumococcal vaccination coverage were 7.3% among patients with newly diagnosed with CRD, 4.8% among cancer patients, 31.0% among HIV patients, and 5.2% among patients underwent transplant. Immunocompromised patients with more hospitalizations during the follow-up period had higher coverage, except for HIV patients. Coverage was consistently higher with more visits to doctor office and pharmacy across all immunocompromising conditions. The majority of immunocompromised patients received their vaccines at the primary care physician’s (PCP) office (68.4% among patients with CRD, 70.0% among cancer, and 75.0% among transplant) except for HIV patients (45.2% at PCP office vs. 45.7% at specialist office). Vaccination out-of-pocket costs ranged from $3.41 (HIV) to $11.06(CRD) for immunocompromised patients. CONCLUSIONS: Pneumococcal vaccination coverage was highest in HIV patients and lowest in cancer patients among all immunocompromising conditions. However, even HIV population did not meet Healthy people 2020 target for immunocompromised patients (60%). A more efficient immunization strategy should be developed to improve pneumococcal vaccination coverage for the immunocompromised adults.