Who Should Be Vaccinated and When?
Vaccination with pneumococcal conjugate vaccine (PCV13) is recommended for all infants and children at ages 2, 4, and 6 months with a booster at age 12-15 months. For incomplete or unvaccinated children, catch-up vaccination should occur through age 59 months.
Vaccination with pneumococcal polysaccharide vaccine (PPSV23) is recommended for all people who meet any of the criteria below:
- All adults age 65 yrs and older
- Age 2 through 64 yrs with any of the following conditions:
- cigarette smokers age 19 yrs and older
- chronic cardiovascular disease (e.g. congestive heart failure, cardiomyopathies)
- chronic pulmonary disease (including asthma in people age 19 yrs and older)
- diabetes mellitus; alcoholism or chronic liver disease
- candidate for or recipient of cochlear implant
- cerebrospinal fluid leak
- functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
- immunocompromising conditions ( e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin’ disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy
- solid organ transplantation; for bone marrow transplantation, see www.cdc.gov/vaccines/pubs/hemato-cell-transplts.htm
- chronic renal failure or nephrotic syndrome
Vaccination with pneumococcal conjugate vaccine (PCV13) is recommended for all children and adults ages 6 yrs and older who meet any of the criteria in categories e-j above.
Who Needs an Additional Dose of PPSV23?
An additional dose of PPSV23 is indicated for people who are
- Age 65 yrs and older and previously vaccinated with PPSV before age 65 yrs if 5 yrs (or more)have elapsed since previous PPSV dose; if previous PCV13 dose, wait at least 8 wks after PCV13
- Children and adults through age 64 yrs who are at highest risk or serious pneumococcal disease or likely to have a rapid decline in pneumococcal antibody levels (categories g-j above)
Vaccine Dosing and Administration
- Administer 0.5 mL PPSV23 or PCV13 intramuscularly (22-25g; needle length according to the patient’s age/body mass [1-1.5”]); PPSV23 may also be given subcutaneously (23-25g, 5/8” needle).
- Children 2 yrs and older who previously received pneumococcal conjugate vaccine (PCV13), and who need a first dose of PPSV23, should wait at least 8 wks following the last dose of PCV13 before receiving PPSV23.
- People age 2 yrs and older in need of a second PPSV23 should wait at least 5 yrs following their first PPSV dose.
- For older children, teens, and adults who need PCV13 and PPSV23, give PCV13 first, followed by PPSV23 at least 8 wks later. If previously vaccinated with PPSV, give children PCV13 at least 8 wks after the most recent dose of PPSV23. Give adults PCV13 12 mos after the most recent dose of PPSV23.
Contraindications and Precautions
- Do not give PPSV23 or PCV13 to patients who have a history of a serious reaction (e.g., anaphylaxis) after a previous dose of PCV13, PPSV, or one of their components.
- Do not give PPSV23 and PCV13 simultaneously; see “Vaccine Dosing and Administration” section above.
Most common side effects from either PPSV23 or PCV13 are soreness and redness at the injection site, lasting 1-2 days.
Key Points for Patients
- Streptococcus pneumoniae bacteria (i.e., pneumococci) are usually found in the upper respiratory tract of most people.
- Pneumococcal disease most commonly presents as a serious infection in the lungs (pneumonia), blood (bacteremia), or brain (meningitis). The annual U.S. case estimate for invasive pneumococcal disease (bacteremia and/or meningitis) is nearly 40,000 cases and 4,250 deaths.
- Pneumococcal disease most often occurs in older people, as well as in people with a predisposing condition (e.g., immunosuppression, pulmonary disease, heart disease, diabetes).
- PPSV23 is 60-70% effective in preventing serious pneumococcal disease; it does not provide substantial protection against all types of pneumonia(viral and bacterial). It is not a “pneumonia” vaccine.
- Patients recommended to receive PPSV23 who can’t remember ever having received it should be vaccinated now.