Pneumococcal Vaccination: Summary of Who and When to Vaccinate

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

  • Pneumococcal conjugate vaccines (PCVs, specifically PCV15 and PCV20)
  • Pneumococcal polysaccharide vaccine (PPSV23)

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

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Children Younger Than 2 Years Old

Routine Vaccination

  • Give 1 dose of PCV15 or PCV20 at 2 months, 4 months, 6 months, and 12 through 15 months.

Children who miss their shots or start the series later than recommended should still get vaccinated. The number of doses recommended and the intervals between doses will depend on the child’s age when vaccination begins. See table 2 of the Child and Adolescent Immunization Schedule for additional details.

Catch-Up Guidance Job Aid

Pneumococcal Conjugate Vaccine Catch-Up Guidance for Healthy Children 4 Months through 4 Years of Age
This job aid should assist clinicians in interpreting table 2 of the child and adolescent immunization schedule.

Children 2 Through 4 Years Old Without Certain Risk Conditions

Catch-Up Guidance

For these children who are unvaccinated or received an incomplete PCV series:

  • Give 1 dose of PCV15 or PCV20. Regardless of vaccine used, their vaccines are then complete.

See table 2 of the Child and Adolescent Immunization Schedule for additional details.

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.

Children 2 Through 5 Years Old With Certain Risk Conditions

For a child with any of these conditions:

  • Cerebrospinal fluid leak
  • Chronic heart disease, particularly cyanotic congenital heart disease and cardiac failure
  • Chronic kidney disease, excluding maintenance dialysis or nephrotic syndrome*
  • Chronic liver disease
  • Chronic lung disease, including moderate persistent or severe persistent asthma
  • Cochlear implant
  • Decreased immune function from disease or drugs (i.e., immunocompromising conditions*)
  • Diabetes mellitus

* Immunocompromising conditions includes:

  • Maintenance dialysis or nephrotic syndrome
  • Congenital or acquired asplenia, or splenic dysfunction
  • Congenital or acquired immunodeficiency†
  • Diseases or conditions treated with immunosuppressive drugs or radiation therapy‡
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies

† 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, leukemias, lymphomas, malignant neoplasms, and solid organ transplant

PCV Catch-Up Guidance

For these children who are unvaccinated or received an incomplete PCV series with <3 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 have ever received a dose of PCV20.
    • Yes: Their vaccines are complete.
    • No: See “Complete PCV Series that Didn’t Include PCV20” below.

For these children who received 3 PCV doses before 12 months but have not received their fourth booster dose:

  • Give 1 dose of PCV15 or PCV20.
  • Determine if they received a dose of PCV20.
    • Yes: Their vaccines are complete.
    • No: See “Complete PCV Series that Didn’t Include PCV20” below.

Complete PCV Series That Included PCV20

For these children, their pneumococcal vaccines are complete.

Complete PCV Series That Didn’t Include PCV20

For these children who have a risk condition (see above) other than an immunocompromising condition:

  • Determine if they already received PPSV23.
    • Yes: Their vaccines are complete.
    • No: Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after the last PCV dose. Regardless of vaccine used, their vaccines are then complete.

For these children who have an immunocompromising condition:

  • Determine if they already received PPSV23.
    • Yes: No pneumococcal vaccines are recommended at this time.
      Wait until at least 5 years have passed since they received PPSV23 and then give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.
    • No: Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
      When PCV20 is used, their vaccines are then 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 a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.

Children 6 Through 18 Years Old With Certain Risk Conditions

For a child with any of these conditions:

  • Cerebrospinal fluid leak
  • Chronic heart disease, particularly cyanotic congenital heart disease and cardiac failure
  • Chronic kidney disease, excluding maintenance dialysis or nephrotic syndrome*
  • Chronic liver disease
  • Chronic lung disease, including moderate persistent or severe persistent asthma
  • Cochlear implant
  • Decreased immune function from disease or drugs (i.e., immunocompromising conditions*)
  • Diabetes mellitus

* Immunocompromising conditions includes:

  • Maintenance dialysis or nephrotic syndrome
  • Congenital or acquired asplenia, or splenic dysfunction
  • Congenital or acquired immunodeficiency†
  • Diseases or conditions treated with immunosuppressive drugs or radiation therapy‡
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies

† 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, leukemias, lymphomas, malignant neoplasms, and solid organ transplant

Never Received PCV13, PCV15, or PCV20

For these children, regardless of risk condition:

  • 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.
    • When PCV15 is used, it should be followed by a dose of PPSV23 if not previously given.
    • When PCV20 is used, it does not need to be followed by a dose of PPSV23.

Received PCV13 or PCV15 Before Age 6 Years, Never Received PCV20

For these children who have a risk condition (see above) other than an immunocompromising condition:

  • Determine if they already received PPSV23.
    • Yes: Their vaccines are complete.
    • No: Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after most recent pneumococcal vaccine dose. Regardless of vaccine used, their vaccines are then complete.

For these children who have an immunocompromising condition:

  • Determine if they already received PPSV23.
    • Yes: No vaccines are recommended at this time.
      Wait until at least 5 years have passed since they received PPSV23 and then give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.
    • No: Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
      When PCV20 is used, their vaccines are then 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 a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.

Adults 19 Through 64 Years Old With Certain Risk Conditions

For adults with any of these conditions or risk factors:

  • Alcoholism or cigarette smoking
  • Cerebrospinal fluid leak
  • Chronic heart disease, including congestive heart failure and cardiomyopathies, excluding hypertension
  • Chronic liver disease
  • Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
  • Cochlear implant
  • Decreased immune function from disease or drugs (i.e., immunocompromising conditions*)
  • Diabetes mellitus

* Immunocompromising conditions include:

  • Chronic renal failure or nephrotic syndrome
  • Congenital or acquired asplenia, or splenic dysfunction
  • Congenital or acquired immunodeficiency†
  • Diseases or conditions treated with immunosuppressive drugs or radiation therapy‡
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies

† 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, leukemias, lymphomas, malignant neoplasms, and solid organ transplant

Never Received Any Pneumococcal Vaccine†

For these adults, regardless of risk condition:

  • Give 1 dose of PCV15 or PCV20.
    • When PCV15 is used, it should be followed by a dose of PPSV23 at 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 vaccines will then be complete.
    • When PCV20 is used, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete.

† Also applies to people who received PCV7 at any age and no other pneumococcal vaccines.

Only Received PPSV23

For these adults, regardless of risk condition:

  • Give 1 dose of PCV15 or PCV20 at least 1 year after the most recent PPSV23 vaccination.
    • Regardless of vaccine given, an additional dose of PPSV23 is not recommended since they already received it. Their vaccines are then complete.

Only Received PCV13

For these adults who have a risk condition (see above) other than an immunocompromising condition:

  • Give 1 dose of PCV20 or PPSV23.
    • The PCV20 dose should be given at least 1 year after PCV13. When PCV20 is used, their vaccines are then complete.
    • The PPSV23 dose should be given at least 8 weeks after PCV13 for those with a cochlear implant or cerebrospinal fluid leak. The PPSV23 dose should be given at least 1 year after PCV13 for any of the other chronic health conditions. When PPSV23 is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when these patients turn 65 years old.

For these adults who have an immunocompromising condition:

  • Give 1 dose of PCV20 or PPSV23.
    • The PCV20 dose should be given at least 1 year after PCV13. When PCV20 is used, their vaccines are then complete.
    • The PPSV23 dose 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 or a second dose of PPSV23. When PCV20 is used, their vaccines will then be 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 these patients turn 65 years old.

Received PCV13 and 1 Dose of PPSV23

For these adults who have a cerebrospinal fluid leak or cochlear implant:

  • Give 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine. Their vaccines are then complete.
    • Note: A second dose of PPSV23 is not recommended at this age for these patients. If PCV20 is not administered, then review pneumococcal vaccine recommendations again when the patient turns 65 years old.

For these adults who have an immunocompromising condition:

  • Give 1 dose of PCV20 or a second PPSV23 dose.
    • The PCV20 dose should be given at least 5 years after the last pneumococcal vaccine. Their vaccines are then complete.
    • The second dose of PPSV23 should be given at least 8 weeks after PCV13 and 5 years after PPSV23. No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when these patients turn 65 years old.

For adults with any other risk condition (see above):

  • No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when these patients turn 65 years old.
Job Aid for Adult Recommendations

Examples: Complete pneumococcal vaccine schedules for adults
Pages 2–4 provide illustrations of vaccine options to complete the recommended pneumococcal vaccines for adults 19–64 years old.

Adults 65 Years or Older

Never Received Any Pneumococcal Vaccine†

For older adults who don’t have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV15 or PCV20.
    • When PCV15 is used, it should be followed by a dose of PPSV23 at least 1 year later. Their vaccines will then be complete.
    • When PCV20 is used, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete.

For older adults who have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV15 or PCV20.
    • When PCV15 is used, it should be followed by a dose of PPSV23 at least 8 weeks later. Their vaccines will then be complete.
    • When PCV20 is used, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete.

†Also applies to people who received PCV7 at any age and no other pneumococcal vaccines.

Only Received PPSV23

  • Give 1 dose of PCV15 or PCV20 at least 1 year after the most recent PPSV23 vaccination.
    • Regardless of vaccine given, an additional dose of PPSV23 is not recommended since they already received it. Their vaccines are then complete.

Only Received PCV13

For older adults who don’t have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV20 or PPSV23 at least 1 year after PCV13. Regardless of vaccine used, their vaccines are then complete. 

For older adults who have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV20 or PPSV23. Regardless of vaccine used, their vaccines are then complete.
    • The PCV20 dose should be given at least 1 year after PCV13.
    • The PPSV23 dose should be given at least 8 weeks after PCV13.

Received PCV13 at Any Age and PPSV23 Before Age 65 Years

For older adults who don’t have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV20 or PPSV23. Regardless of vaccine used, their series is complete.
    • The PCV20 dose should be given at least 5 years after the last pneumococcal vaccine.
    • The PPSV23 dose should be given at least 5 years after the last PPSV23 dose. It should also be given at least 1 year after the PCV13 dose. 

For older adults who have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak:

  • Give 1 dose of PCV20 or PPSV23. Regardless of vaccine used, their series is complete.
    • The PCV20 dose should be given at least 5 years after the last pneumococcal vaccine.
    • The PPSV23 dose should be given at least 5 years after the last PPSV23 dose. It should also be given at least 8 weeks after the PCV13 dose.
Job Aid for Adult Recommendations

Examples: Complete pneumococcal vaccine schedules for adults
The first page provides illustrations of vaccine options to complete the recommended pneumococcal vaccines for older adults.

Received PCV13 at Any Age and PPSV23 After Age 65 Years

  • Use shared clinical decision-making to decide whether to administer PCV20.
    • If so, the dose of PCV20 should be administered at least 5 years after the last pneumococcal vaccine.
Shared Clinical Decision-Making Job Aid

PCV20 Vaccination for Adults 65 Years or Older
This job aid should assist clinicians in discussions with patients about this vaccine recommendation.

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