Administering Pneumococcal Vaccines

This page provides a brief summary of guidance for administering pneumococcal vaccines, including route, number of doses, and co-administration with other vaccines.

Visual Inspection

Do not use any pneumococcal vaccine beyond the expiration date printed on the label.

Prior to administration, visually inspect the vaccine for particulate matter and/or discoloration. If these conditions exist, do NOT use.

Route, Site, and Needle Size

Administer pneumococcal polysaccharide vaccine (PPSV23) intramuscularly or subcutaneously.

Administer pneumococcal conjugate vaccines (PCV15 and PCV20) intramuscularly. For infants and young children, use the vastus lateralis muscle in the anterolateral thigh. For older children and adults, use the deltoid muscle.

Use a needle length appropriate for the age and size of the person receiving the vaccine.

Number and Timing of Doses

The primary series of PCV15 or PCV20 consists of 3 doses routinely given at 2, 4, and 6 months of age. You can administer the first dose as early as 6 weeks of age. CDC recommends a fourth (booster) dose at 12 through 15 months of age. For children vaccinated when they are younger than 12 months of age, the minimum interval between doses is 4 weeks. Separate doses given at 12 months of age and older by at least 8 weeks.

The number and timing of doses for older children and adults depends on the medical indication, prior pneumococcal vaccination, and age. See Pneumococcal Vaccination: Summary of Who and When to Vaccinate for all pneumococcal vaccine recommendations by vaccine and age.

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Predrawing Vaccine Doses

There are no data on the stability of vaccines stored in syringes filled by healthcare professionals. Therefore, CDC does not recommend predrawing vaccine doses. Do not open vaccine vials until time of administration.

Administration with Other Vaccines

Different Pneumococcal Vaccines

Never administer a pneumococcal conjugate vaccine (PCV15 or PCV20) and PPSV23 during the same visit.

If someone is indicated to receive PCV15 and PPSV23, administer PCV15 first followed by PPSV23.

For children (2 through 18 years old), the interval between PCV15 and PPSV23 should be at least 8 weeks. If PPSV23 is inadvertently administered first, wait at least 8 weeks to administer PCV15.

For adults, the recommended interval is at least 1 year. An 8-week minimum interval can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. If PPSV23 is inadvertently administered first wait at least 1 year to administer PCV15.

Table 1: interval between vaccine administrations by age
Age Group Interval Recommendation
(PCV15 then PPSV23, preferred)
Interval Recommendation
(PPSV23 then PCV15)
Children 2 through 18 years old with certain risk conditions* 8 weeks or longer 8 weeks or longer
19 years or older with certain risk conditions* or other risk factors** 1 year or longer 1 year or longer
65 years or older 1 year or longer 1 year or longer

* Conditions that increase someone’s risk for pneumococcal disease include cerebrospinal fluid leak; chronic heart, kidney, liver, or lung disease; cochlear implant; diabetes mellitus; and decreased immune function from disease or drugs (i.e., immunocompromising conditions). Immunocompromising conditions include chronic renal failure (i.e., on maintenance dialysis) or nephrotic syndrome; congenital or acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases or conditions treated with immunosuppressive drugs or radiation therapy, including Hodgkin disease, leukemia, lymphoma, malignant neoplasms, and solid organ transplant; HIV infection; and sickle cell disease or other hemoglobinopathies.
** Other risk factors that increase someone’s risk for pneumococcal disease include alcoholism and cigarette smoking.
† The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.

Other Childhood Vaccines

You can administer PCV15, PCV20, or PPSV23 at the same time as most other routine childhood vaccinations, with one exception.

  • Do not give PCV15 or PCV20 with Menactra®, a meningococcal conjugate vaccine. Children with functional or anatomic asplenia or HIV should NOT receive Menactra® before the age of 2 years. This timing avoids interference with the immunologic response to the infant pneumococcal conjugate vaccination series. CDC recommends infants 2 through 23 months of age with functional or anatomic asplenia or HIV receive Menveo® Two-Vial.

Children may be at increased risk for febrile seizures if a pneumococcal conjugate vaccine is administered with inactivated influenza vaccine. However, clinicians may give either pneumococcal conjugate vaccine at the same time as an influenza vaccine.

Currently, no data from clinical trials are available for co-administration of PPSV23 with other childhood vaccines during the same visit.

Other Vaccines for Adults

In adults, you can administer a pneumococcal vaccine (PCV15, PCV20, or PPSV23) during the same visit with influenza vaccination. Administer each vaccine with a separate syringe and, if feasible, at a different injection site. Annual influenza vaccination is important to help prevent the flu. Additionally, since having the flu increases the risk of getting pneumococcal disease, receiving a flu vaccine is important for preventing pneumococcal disease.

Currently, no data are available on administration of PCV15 or PCV20 during the same visit with other vaccines among adults. This includes tetanus, diphtheria, and acellular pertussis vaccine, zoster vaccine, or respiratory syncytial virus vaccine.

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