Key points
- CDC recommends pneumococcal vaccination for children and adults at increased risk for pneumococcal disease.
- Follow the recommended immunization schedule to ensure that your patients get the pneumococcal vaccines that they need.
- Find resources below, like CDC's free app, to help you implement pneumococcal vaccine recommendations.
App available to interpret recommendations
CDC offers PneumoRecs VaxAdvisor as a free app to quickly and easily provide patient-specific pneumococcal vaccine guidance. It's available for download for iOS and Android mobile devices. There's also a web-based version that doesn't require a download.
Children 2 through 5 years old
The following guidance applies to children in this age group who have a risk condition.
Unvaccinated or <3 PCV doses before age 2 years
Give 2 doses of PCV15 or PCV20. Give the second dose at least 8 weeks after the first.
Determine if they've ever received a dose of PCV20:
- Their pneumococcal vaccinations are complete.
- See "Complete PCV series that didn't include PCV20" guidance below.
3 PCV doses before age 12 months but no booster dose at or after age 12 months
Give 1 dose of PCV15 or PCV20.
Determine if they've ever received a dose of PCV20:
- Their pneumococcal vaccinations are complete.
- See "Complete PCV series that didn't include PCV20" guidance below.
Complete PCV series that included PCV20
Their pneumococcal vaccines are complete.
Complete PCV series that didn't include PCV20
Recommendations depend on if the child's risk condition is an immunocompromising condition.
Immunocompromising condition
Determine if they have ever received a dose of PPSV23:
- Then no pneumococcal vaccines are recommended at this time.
- Wait until at least 5 years have passed since they received their first PPSV23 dose.
- Then give 1 dose of PCV20 or PPSV23. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
- Give 1 dose of PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
- When PCV20 is used, their pneumococcal vaccinations are then complete.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give 1 dose of PCV20 or PPSV23. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
Not an immunocompromising condition
Determine if they have ever received a dose of PPSV23:
- Their pneumococcal vaccinations are complete.
- Give 1 dose of PCV20 or PPSV23 at least 8 weeks after last PCV dose. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
Children 6 through 18 years old
The following guidance applies to children in this age group who have a risk condition.
Never received PCV13, PCV15, or PCV20
Give 1 dose of PCV15 or PCV20 at least 8 weeks after the most recent pneumococcal vaccine dose. Give it regardless of whether the child has previously received PPSV23 or PCV7.
- It should be followed by a dose of PPSV23 if not previously given.
- It doesn't need to be followed by a dose of PPSV23. Their pneumococcal vaccinations are complete.
Received PCV13 or PCV15 before age 6 years, never received PCV20
Recommendations depend on if the child's risk condition is an immunocompromising condition.
Immunocompromising condition
Determine if they already received PPSV23:
- Then no pneumococcal vaccines are recommended at this time.
- Wait until at least 5 years have passed since they received their first PPSV23 dose.
- Then give 1 dose of PCV20 or PPSV23. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
- Give 1 dose of PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
- When PCV20 is used, their pneumococcal vaccinations are complete.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give either 1 dose of PCV20 or PPSV23. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
Not an immunocompromising condition
Determine if they already received PPSV23:
- Their pneumococcal vaccinations are complete.
- Give 1 dose of PCV20 or PPSV23 at least 8 weeks after the most recent pneumococcal vaccine dose. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are then complete.
Adults 19 through 64 years old
The following guidance applies to adults younger than 65 years who have a risk condition.
Job Aid for Adult Recommendations
Serotype 4 background information
PCV21 contains eight new pneumococcal serotypes not included in PCV15, PCV20, or PPSV23. However, PCV21 doesn't contain certain pneumococcal serotypes (e.g., serotype 4) included in other pneumococcal vaccines.
Populations at risk
In certain adult populations in the Western United States with data (Alaska, Colorado, New Mexico, Navajo Nation, and Oregon), serotype 4 has caused high percentages (i.e., ≥30%) of invasive pneumococcal disease (IPD). CDC currently doesn't know if this is seen in other parts of the Western United States that don't routinely monitor IPD data.
Typically, individuals living within these geographic areas who develop serotype 4 IPD are adults aged <65 years with specific underlying conditions or risk factors such as:
- Alcoholism
- Chronic lung disease
- Cigarette smoking
- Homelessness
- Injection drug use
Importantly, these individuals usually haven't received a PCV containing serotype 4.
Serotype 4 coverage and vaccine choice
In such populations, other recommended pneumococcal vaccines (e.g., PCV20 alone or both PCV15 and PPSV23) are expected to provide broader serotype coverage against locally circulating strains compared to PCV21 alone.
Never received any pneumococcal vaccineA
Give 1 dose of PCV15, PCV20, or PCV21:
- It should be followed by a dose of PPSV23 Bat least 1 year later. The minimum interval (8 weeks) can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. Their pneumococcal vaccinations are then complete.
- It doesn't need to be followed by a dose of PPSV23. Regardless of vaccine used (PCV20 or PPSV23), their pneumococcal vaccinations are complete.
Only received PPSV23
Give 1 dose of PCV15, PCV20, or PCV21 at least 1 year after the most recent PPSV23 vaccination. Regardless of which vaccine is used (PCV15, PCV20, or PCV21), an additional dose of PPSV23 isn't recommended. Their pneumococcal vaccinations are complete.
Only received PCV13
Recommendations depend on the person's risk condition.
Immunocompromising condition
Give 1 dose of PCV20, PCV21, or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 or PCV21 is used, their pneumococcal vaccinations are then complete.
- It should be given at least 8 weeks after PCV13.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give either 1 dose of PCV20, PCV21, or PPSV23.
- When PCV20 or PCV21 is used, their pneumococcal vaccinations are then complete.
- When a second PPSV23 dose is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Cerebrospinal fluid leak or cochlear implant
Give 1 dose of PCV20, PCV21, or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 or PCV21 is used, their pneumococcal vaccinations are then complete.
- It should be given at least 8 weeks after PCV13.
- When PPSV23 is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Other risk conditionC
Give 1 dose of PCV20, PCV21, or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 or PCV21 is used, their pneumococcal vaccinations are then complete.
- It should be given at least 1 year after PCV13.
- When PPSV23 is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Received PCV13 and 1 dose of PPSV23
Recommendations depend on the person's risk condition.
Immunocompromising condition
Give 1 dose of PCV20, PCV21, or PPSV23:
- It should be given at least 5 years after the last pneumococcal vaccine.
- When PCV20 or PCV21 is used, their pneumococcal vaccinations are then complete.
- It should be given at least 8 weeks after PCV13 and 5 years after first PPSV23 dose. No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Cerebrospinal fluid leak or cochlear implant
Give 1 dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccine. Regardless of which vaccine is used (PCV20 or PCV21), their pneumococcal vaccinations are then complete.
Note: A second dose of PPSV23 isn't recommended at this age for these patients. If PCV20 or PCV21 isn't administered, then review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Other risk conditionC
No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Risk conditions
Children and adults
Many conditions are an indication for pneumococcal vaccination for both children and adults:
- Cerebrospinal fluid leak
- Chronic liver disease
- Cochlear implant
- An immunocompromising condition
- Diabetes mellitus
The following are considered immunocompromising conditions in both children and adults:
- Congenital or acquired asplenia, or splenic dysfunction
- Congenital or acquired immunodeficiencyD
- Diseases or conditions treated with immunosuppressive drugs or radiation therapyE
- HIV infection
- Sickle cell disease or other hemoglobinopathy
Children specifically
The following risk conditions are only an indication for pneumococcal vaccination of children:
- Chronic heart disease
- Particularly cyanotic congenital heart disease and cardiac failure
- Particularly cyanotic congenital heart disease and cardiac failure
- Chronic kidney disease, excluding maintenance dialysis or nephrotic syndrome
- Chronic lung disease
- Includes moderate persistent or severe persistent asthma
- Includes moderate persistent or severe persistent asthma
- Maintenance dialysis or nephrotic syndrome
Adults specifically
The following risk conditions are only an indication for pneumococcal vaccination of adults:
- Alcoholism or cigarette smoking
- Chronic heart disease
- Includes congestive heart failure and cardiomyopathies
- Excludes hypertension
- Includes congestive heart failure and cardiomyopathies
- Chronic lung disease
- Includes chronic obstructive pulmonary disease, emphysema, and asthma
- Includes chronic obstructive pulmonary disease, emphysema, and asthma
- Chronic renal failure or nephrotic syndrome
- Also applies to people who received PCV7 at any age and no other pneumococcal vaccines.
- If PPSV23 is not available, one dose of PCV20 or PCV21 may be given.
- e.g., alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes mellitus
- Includes B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
- Includes Hodgkin disease, leukemia, lymphoma, malignant neoplasm, and solid organ transplant