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Administering Pneumococcal Vaccines

One of the Recommended Vaccines by Disease

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 intramuscularly or subcutaneously. Administer pneumococcal conjugate vaccine intramuscularly. The preferred site for infants and young children is the vastus lateralis muscle in the anterolateral thigh. The preferred injection site in older children and adults is the deltoid muscle. Use a needle length appropriate for the age and size of the person receiving the vaccine.

 

Number and Timing of Doses

Vaccinate all children younger than 2 years old with pneumococcal conjugate vaccine (PCV13 or Prevnar13®). The primary series consists of three 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 at 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.

Adults 65 years or older who have not previously received PCV13 or whose previous vaccination history is unknown should receive a dose of PCV13. Administer a dose of pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) at least 1 year after PCV13 for most immunocompetent adults. Administer PPSV23 at least 8 weeks later for adults with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants.

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Pneumococcal Vaccine Timing

Pneumococcal Vaccine Timing

Pneumococcal Vaccine Timing for Adults [4 pages]
Summarizes how to implement adult pneumococcal vaccination recommendations.

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 pneumococcal conjugate and polysaccharide vaccines during the same visit. If a patient needs both vaccines, you should administer PCV13 first, followed by PPSV23 at another visit. The interval between administrations depends on the age of the patient, the indication for giving it, and which vaccine you administer first. See the table below for additional information.

Age Group Interval Recommendation
(PCV13 then PPSV23, preferred)
Interval Recommendation
(PPSV23 then PCV13)
24 through 71 month olds 8 weeks or longer 8 weeks or longer
6 through 18 year olds 8 weeks or longer 8 weeks or longer
19 or older with certain medical conditions* 8 weeks or longer 1 year or longer
65 or older and immunocompetent (i.e., no medical conditions listed below*) 1 year or longer 1 year or longer

* Medical conditions include cochlear implants, cerebrospinal fluid leaks, functional or anatomic asplenia, and immunocompromising conditions like HIV infection, cancer, or chronic renal failure.

 

For Kids

You can administer PCV13 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. CDC does NOT recommend children with functional or anatomic asplenia receive Menactra® until 2 years of age. This avoids interference with the immunologic response to the infant series of PCV13. CDC recommends that infants 2 through 23 months of age with functional or anatomic asplenia either receive Menveo® or MenHibrix® or wait until 2 years of age to receive Menactra®.

Giving influenza vaccine with PCV13 increases the risk for febrile seizures in children according to a Vaccine Safety Datalink study. However, CDC made no changes in the recommendations; these vaccines may be given at the same time. 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).

Administering PCV13 concurrently with vaccines containing the following antigens is not known to have any adverse effects on immunogenicity or safety: diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, inactivated poliomyelitis, rotavirus, hepatitis B, meningococcal serogroup C, 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 either pneumococcal vaccine (PCV13 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, flu vaccine is important in preventing pneumococcal disease.

  • A randomized double-blind trial with adults 65 years old or older found that concomitant administration of PCV13 and TIV produced a reduced immune response for some pneumococcal serotypes and one influenza subtypes (influenza A [H3N2]) compared to individuals who received PCV13 alone or TIV alone. However, studies demonstrate concomitant administration of PCV13 and TIV is immunogenic and safe. You can administer PCV13 during the same visit with TIV in an adult immunization program.
  • Currently, no data are available on administration of PCV13 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.

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