Pneumococcal Vaccination: Summary of Who and When to Vaccinate

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There are 2 types of pneumococcal vaccines available in the United States:

  • Pneumococcal conjugate vaccine (PCV13 or Prevnar13®)
  • Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®)

Learn more below about which pneumococcal vaccines CDC recommends by age group and medical condition.

Children Younger than 2 Years Old

CDC recommends PCV13 for all infants as a series of 4 doses.

  • Give 1 dose at 2 months, 4 months, 6 months, and 12 through 15 months.

Children who miss their shots or start the series later should still get the vaccine. The number of doses recommended and the intervals between doses will depend on the child’s age when vaccination begins. See the Childhood/Adolescent Immunization Catch-up Schedule for additional details.

Children 2 through 4 Years Old without Certain Medical Conditions

Incomplete Schedule

CDC defines an incomplete schedule as not having received all of the recommended age appropriate primary series or not having received all of an age appropriate catch up schedule.

CDC recommends PCV13 vaccination for children 2 through 4 years old who are unvaccinated or received an incomplete PCV13 series. See the Childhood/Adolescent Immunization Catch-up Schedule for additional details.

  • Give 1 dose of PCV13.

Children 2 through 5 Years Old with Certain Medical Conditions

CDC recommends pneumococcal vaccination for children 2 through 5 years old who have certain medical conditions. The tables below provide detailed information by medical condition. You can also see table 11 for additional details.

For a child with any of these conditions:

  • Chronic heart disease
  • Chronic lung disease, including asthma if treated with high-dose oral corticosteroid therapy
  • Diabetes mellitus
  • Cerebrospinal fluid leaks
  • Cochlear implant(s)

CDC recommends you:

  • Give 2 doses of PCV13 if they are unvaccinated or received an incomplete PCV13 series with <3 doses. Give the second dose at least 8 weeks after the first.
  • Give 1 dose of PCV13 if they received 3 doses of PCV13 but none were given after 12 months of age.
  • Give 1 dose of PPSV23 at least 8 weeks after the PCV13 series is complete.

For a child with any of these conditions:

  • Sickle cell disease or other hemoglobinopathies
  • Anatomic or functional asplenia
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic renal failure or nephrotic syndrome
  • Iatrogenic immunosuppression, including radiation therapy
  • Leukemia or lymphoma
  • Hodgkin disease
  • Generalized and metastatic malignancies
  • Solid organ transplant

CDC recommends you:

  • Give 2 doses of PCV13 if they are unvaccinated or received an incomplete PCV13 series with <3 doses. Give the second dose at least 8 weeks after the first.
  • Give 1 dose of PCV13 if they received 3 doses of PCV13 but none were given after 12 months of age.
  • Give 2 doses of PPSV23 after the PCV13 series is complete. Give the first dose at least 8 weeks after any prior PCV13 dose, then give the second dose of PPSV23 at least 5 years after the first PPSV23 dose.

Children 6 through 18 Years Old with Certain Medical Conditions

CDC recommends pneumococcal vaccination for children 6 through 18 years old who have certain medical conditions. The tables below provide detailed information by medical condition. See this table for additional details.

For a child with any of these conditions:

  • Cerebrospinal fluid leaks
  • Cochlear implant(s)

CDC recommends you:

  • Give 1 dose of PCV13 if they have not received any doses of PCV13. Administer PCV13 before giving any recommended doses of PPSV23.
  • Give 1 dose of PPSV23 (if not already given earlier in childhood) at least 8 weeks after PCV13.

For a child with any of these conditions:

  • Sickle cell disease or other hemoglobinopathies
  • Anatomic or functional asplenia
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic renal failure or nephrotic syndrome
  • Iatrogenic immunosuppression, including radiation therapy
  • Leukemia or lymphoma
  • Hodgkin disease
  • Multiple myeloma
  • Generalized and metastatic malignancies
  • Solid organ transplant

CDC recommends you:

  • Give 1 dose of PCV13 if they have not received any doses of PCV13. Administer PCV13 before giving any recommended doses of PPSV23.
  • Ensure the child receives 2 doses of PPSV23. The first dose of PPSV23 should be given at least 8 weeks after any prior PCV13 dose, then the second dose of PPSV23 should be given at least 5 years after the first dose of PPSV23.

For a child with any of these conditions:

    • Chronic heart disease
    • Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma (if treated with high-dose oral corticosteroid therapy)
    • Diabetes mellitus

CDC recommends you:

  • Give 1 dose of PPSV23 (if not already given earlier in childhood).

Adults 19 through 64 Years

CDC recommends pneumococcal vaccination for adults 19 through 64 years old who have certain medical conditions or who smoke. The tables below provide detailed information by medical condition and smoking status. See Pneumococcal Vaccine Timing for Adults pdf icon[5 pages] for additional details.

For anyone with any of the conditions listed below who has not previously received the recommended pneumococcal vaccines:

  • Cerebrospinal fluid leaks
  • Cochlear implant(s)

CDC recommends you:

  • Give 1 dose of PCV13 and 1 dose of PPSV23. Administer PCV13 first, then give the PPSV23 dose at least 8 weeks later.

For anyone with any of the conditions listed below who has not previously received the recommended pneumococcal vaccines:

  • Sickle cell disease or other hemoglobinopathies
  • Anatomic or functional asplenia
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic renal failure or nephrotic syndrome
  • Leukemia or lymphoma
  • Hodgkin disease
  • Generalized and metastatic malignancies
  • Iatrogenic immunosuppression, including radiation therapy
  • Solid organ transplant
  • Multiple myeloma

CDC recommends you:

  • Give 1 dose of PCV13 and 2 doses of PPSV23. Administer PCV13 first, then give the first PPSV23 dose at least 8 weeks later. Give the second dose of PPSV23 at least 5 years after the first dose of PPSV23.
For anyone who smokes and has not previously received the recommended pneumococcal vaccine

CDC recommends you:

  • Give 1 dose of PPSV23.

For anyone with any of the conditions listed below who has not previously received the recommended pneumococcal vaccine:

  • Alcoholism
  • Chronic heart disease
  • Chronic liver disease
  • Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
  • Diabetes mellitus

CDC recommends you:

  • Give 1 dose of PPSV23.

Adults 65 Years or Older without an Immunocompromising Condition, Cochlear Implant, or Cerebrospinal Fluid Leak

Expert Commentary

CDC, Medscape from WebMD

CDC-Medscape video: Updated Pneumococcal Vaccine Recommendations for Older Adults

CDC Commentary – Updated Recommendations for PCV13 Use in Older Adultsexternal icon

Running Time: 5:08 mins
Date Released: 01/31/2020

Learn about considerations for this new shared clinical decision-making recommendation.

CDC recommends pneumococcal vaccination for all adults 65 years or older. See Pneumococcal Vaccine Timing for Adults pdf icon[5 pages] for additional details.

All adults 65 years or older should receive 1 dose of PPSV23. In addition, clinicians should consider discussing PCV13 vaccination with their adult patients 65 years or older who do not have an immunocompromising condition†, cochlear implant, or cerebrospinal fluid leak and who have never received PCV13 before. When patients and clinicians engage in shared clinical decision-making for PCV13 use, considerations may include the individual patient’s risk of exposure to PCV13 serotypes and the risk of pneumococcal disease for that individual because of underlying medical conditions.

  • For adults 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive PPSV23 ONLY:
    • Administer 1 dose of PPSV23.
      • Anyone who received any doses of PPSV23 before age 65 should receive 1 final dose of the vaccine at age 65 or older. Administer this last dose at least 5 years after the prior PPSV23 dose.
    • For adults 65 years or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive PCV13 AND PPSV23:
      • Administer 1 dose of PCV13 first then give 1 dose of PPSV23 at least 1 year later.
        • Anyone who received any doses of PPSV23 before age 65 should receive 1 final dose of the vaccine at age 65 or older. Administer this last dose at least 5 years after the prior PPSV23 dose.
        • If the patient already received PPSV23, give the dose of PCV13 at least 1 year after they received the most recent dose

Considerations for Shared Clinical Decision-Making for PCV13 Use among Adults 65 Years or Older

Clinicians and older adults may want to consider the following when making this decision:

  • PCV13 is a safe and effective vaccine for older adults. The risk for PCV13-type disease among adults aged ≥65 years is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects (reduced population carriage and transmission). The remaining risk is a function of each individual patient’s risk of exposure to PCV13 serotypes and the influence of underlying medical conditions on the patient’s risk of developing pneumococcal disease if exposure occurs.
  • The following adults aged ≥65 years are potentially at increased risk of exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination, and providers/practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged ≥65 years who have not previously received PCV13:
    • Persons residing in nursing homes or other long-term care facilities
    • Persons residing in settings with low pediatric PCV13 uptake (use ChildVaxView Interactive! to find state and selected local area data)
    • Persons traveling to settings with no pediatric PCV13 program (use VIEW-hubexternal icon to see which countries use PCV13)
  • Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with increasing age and is higher among persons with chronic heart, lung, or liver disease, diabetes, or alcoholism, and those who smoke cigarettes or who have more than one chronic medical condition. While indirect effects from pediatric PCV13 use were documented for these groups of adults and were comparable to those observed among healthy adults, the residual PCV13-type disease burden remains higher in these groups. Providers/practices caring for patients with these medical conditions may consider offering PCV13 to such patients who are aged ≥65 years and who have not previously received PCV13.

Footnote

† Immunocompromising conditions include: chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.

Adults 65 Years or Older with an Immunocompromising Condition, Cochlear Implant, or Cerebrospinal Fluid Leak

CDC recommends pneumococcal vaccination for all adults 65 years or older. See Pneumococcal Vaccine Timing for Adults pdf icon[5 pages] for additional details.

For anyone with any of the conditions listed below who has not previously received the recommended pneumococcal vaccines:

  • Cerebrospinal fluid leaks
  • Cochlear implant(s)
  • Sickle cell disease or other hemoglobinopathies
  • Anatomic or functional asplenia
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic renal failure or nephrotic syndrome
  • Leukemia or lymphoma
  • Hodgkin disease
  • Generalized and metastatic malignancies
  • Iatrogenic immunosuppression, including radiation therapy)
  • Solid organ transplant
  • Multiple myeloma

CDC recommends you:

  • Give 1 dose of PCV13 first.
  • Give 1 dose of PPSV23 at least 8 weeks after any prior PCV13 dose and at least 5 years after any prior PPSV23 dose.
    • Anyone who received any doses of PPSV23 before age 65 should receive 1 final dose of the vaccine at age 65 or older.

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Page last reviewed: August 7, 2020