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 (PCV13, PCV15, and PCV20) intramuscularly. The preferred site for PCV13 or PCV15 vaccination in infants and young children is the vastus lateralis muscle in the anterolateral thigh. The deltoid muscle is the preferred injection site for PCV13 or PCV15 vaccination in older children and PCV15 or PCV20 vaccination in adults. 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 PCV13 or PCV15 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.

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

Never administer a pneumococcal conjugate vaccine (PCV13, PCV15, or PCV20) and PPSV23 during the same visit.

If a child (2 through 18 years old) is indicated to receive both a pneumococcal conjugate vaccine (PCV13 or PCV15) and PPSV23, administer the pneumococcal conjugate vaccine first, followed by PPSV23 at least 8 weeks later. If PPSV23 is inadvertently administered first, wait at least 8 weeks before administering PCV13 or PCV15.

Table 1: interval between vaccine administrations by age

Age Group	Interval Recommendation (PCV13 or PCV15 then PPSV23, preferred)	Interval Recommendation (PPSV23 then PCV13 or PCV15)
Children 2 through 18 years old with certain medical conditions*	8 weeks or longer	8 weeks or longer

If an adult is indicated to receive both PCV15 and PPSV23, administer PCV15 first, followed by PPSV23 at least 1 year later (recommended interval). The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. If PPSV23 is inadvertently administered first, wait at least 1 year before administering PCV15 (recommended and minimum interval).

 

Table 2: interval between vaccine administrations by age

Age Group	Interval Recommendation† (PCV15 then PPSV23, preferred)	Interval Recommendation (PPSV23 then PCV15)
19 years or older with certain medical 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

* Medical conditions that increase someone’s risk for pneumococcal disease include cerebrospinal fluid leak, chronic heart/liver/lung disease, chronic renal failure or nephrotic syndrome, cochlear implant, congenital or acquired asplenia, diabetes mellitus, generalized malignancy, HIV infection, Hodgkin disease, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, sickle cell disease or other hemoglobinopathies, and solid organ transplant.
** 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.

For Children

You can administer PCV13, PCV15, or PPSV23 at the same time as most other routine childhood vaccinations, with one exception.

• Do not give PCV13 with Menactra^®, a meningococcal conjugate vaccine. Similar precautions should be used for PCV15. 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^®.

Giving inactivated influenza vaccine with PCV13 increases the risk for febrile seizures in children according to a Vaccine Safety Datalink study. Currently, we do not know the risk of febrile seizures when PCV15 is given at the same time as the inactivated influenza vaccine. However, clinicians may give either pneumococcal conjugate vaccine at the same time as an influenza vaccine. The study looked at trivalent inactivated influenza vaccine (TIV or IIV) and PCV13 for the 2006–07 through 2010–2011 influenza seasons and the 2014–15 season. The findings showed that PCV13 and diphtheria, tetanus, and acellular pertussis vaccine (DTaP) both increase risk of febrile seizure when given at the same time as the influenza vaccine. CDC found that administering TIV alone was not associated with an increased risk of febrile seizures (in the influenza seasons studied).

There are no known adverse effects on immunogenicity or safety when administering PCV13 concurrently with vaccines containing the following antigens:

• Diphtheria, tetanus, or acellular pertussis
• Haemophilus influenzae type b
• Inactivated poliomyelitis
• Rotavirus
• Hepatitis B
• Meningococcal serogroup C
• Measles, mumps, rubella, or varicella

Clinical trial data for PCV15 showed immunogenicity and safety responses that were similar to those responses in children who received PCV13 when PCV13 or PCV15 was given at the same time as the following antigens:

• Haemophilus influenzaetype b
• Rotavirus
• Hepatitis A
• Hepatitis B
• Measles, mumps, rubella, or varicella

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

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 (e.g., tetanus, diphtheria, and acellular pertussis vaccine or zoster vaccine) among adults.
• A randomized clinical study found that concomitant administration of PPSV23 and zoster vaccine produced a reduced immune response to zoster compared with individuals who received these vaccines 4 weeks apart. However, to avoid introducing barriers to vaccination, CDC continues to recommend administration of zoster vaccine and PPSV23 at the same visit if the person is eligible for both vaccines.