Pneumococcal Vaccine


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
    • 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.

Side Effects

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.

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