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 vaccines (PCV13, PCV15, and PCV20)
  • Pneumococcal polysaccharide vaccine (PPSV23)

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

Children Younger than 2 Years Old

CDC recommends PCV13 or PCV15 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 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 the Childhood/Adolescent Immunization Catch-up Schedule for additional details.

Graphic of someone holding a mobile phone displaying the PnuemoRecs VaxAdvisor app. PneumoRecs VaxAdvisor: Customized pneumococcal vaccination recommendations at your fingertips.

PneumoRecs VaxAdvisor is available for download on iOS and Android mobile devices.

Children 2 through 4 Years Old without Certain Medical Conditions

CDC recommends PCV13 or PCV15 vaccination for children 2 through 4 years old who are unvaccinated or received an incomplete pneumococcal conjugate vaccine (either PCV13 or PCV15) series. PCV13 and PCV15 can be used interchangeably. See the Childhood/Adolescent Immunization Catch-up Schedule for additional details.

  • Give 1 dose of PCV13 or PCV15.
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 Medical Conditions

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

For a child with any of these conditions:

  • Cerebrospinal fluid leak
  • Chronic heart disease, particularly cyanotic congenital heart disease and cardiac failure
  • Chronic lung disease, including asthma if treated with prolonged high-dose oral corticosteroid therapy
  • Cochlear implant
  • Diabetes mellitus

CDC recommends you:

  • Give 2 doses of a pneumococcal conjugate vaccine (either PCV13 or PCV15) if they are unvaccinated or received an incomplete pneumococcal conjugate vaccine series with <3 doses before 24 months of age. Give the second dose at least 8 weeks after the first.
  • Give 1 dose of PCV13 or PCV15 if they received 3 doses of a pneumococcal conjugate vaccine before 12 months but have not received their fourth booster dose.
  • Give 1 dose of PPSV23 at least 8 weeks after the pneumococcal conjugate vaccine series is complete.

For a child with any of these conditions:

  • Chronic renal failure or nephrotic syndrome
  • Congenital immunodeficiency
    • B- (humoral) or T-lymphocyte deficiency
    • Complement deficiency, particularly C1, C2, C3, or C4 deficiency
    • Phagocytic disorder, excluding chronic granulomatous disease
  • Congenital or acquired asplenia, or splenic dysfunction
  • Diseases associated with treatment of immunosuppressive drugs or radiation therapy
    • Hodgkin disease
    • Leukemia
    • Lymphoma
    • Malignant neoplasm
    • Solid organ transplant
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies

CDC recommends you:

  • Give 2 doses of a pneumococcal conjugate vaccine (either PCV13 or PCV15) if they are unvaccinated or received an incomplete pneumococcal conjugate vaccine series with <3 doses before 24 months of age. Give the second dose at least 8 weeks after the first.
  • Give 1 dose of PCV13 or PCV15 if they received 3 doses of a pneumococcal conjugate vaccine before 12 months but have not received their fourth booster dose.
  • Give 2 doses of PPSV23 after the pneumococcal conjugate vaccine series is complete. Give the first dose at least 8 weeks after any prior pneumococcal conjugate vaccine 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 that increase their risk of pneumococcal disease. The tables below provide detailed information by medical condition. See table 3 for additional details.

For a child with any of these conditions:

  • Cerebrospinal fluid leak
  • Cochlear implant

CDC recommends you:

  • Give 1 dose of a pneumococcal conjugate vaccine (either PCV13 or PCV15) if they have not received any doses of a pneumococcal conjugate vaccine. Administer PCV13 or PCV15 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 or PCV15.

For a child with any of these conditions:

  • Chronic renal failure or nephrotic syndrome
  • Congenital immunodeficiency
    • B- (humoral) or T-lymphocyte deficiency
    • Complement deficiency, particularly C1, C2, C3, or C4 deficiency
    • Phagocytic disorder, excluding chronic granulomatous disease
  • Congenital or acquired asplenia, or splenic dysfunction
  • Diseases associated with treatment of immunosuppressive drugs or radiation therapy
    • Hodgkin disease
    • Leukemia
    • Lymphoma
    • Malignant neoplasm
    • Solid organ transplant
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies

CDC recommends you:

  • Give 1 dose of a pneumococcal conjugate vaccine (either PCV13 or PCV15) if they have not received any doses of a pneumococcal conjugate vaccine. Administer PCV13 or PCV15 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 pneumococcal conjugate vaccine 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, particularly cyanotic congenital heart disease and cardiac failure
  • Chronic lung disease, including asthma if treated with prolonged 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 Old

CDC recommends pneumococcal vaccination for adults 19 through 64 years old who have certain chronic medical conditions or other risk factors. The tables below provide detailed information.

For adults with any of the conditions or risk factors listed below:

  • Alcoholism
  • Cerebrospinal fluid leak
  • Chronic heart disease, including congestive heart failure and cardiomyopathies
  • Chronic liver disease
  • Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
  • Chronic renal failure*
  • Cigarette smoking
  • Cochlear implant
  • Congenital or acquired asplenia*
  • Congenital or acquired immunodeficiency*
    • B- (humoral) or T-lymphocyte deficiency
    • Complement deficiency, particularly C1, C2, C3, or C4 deficiency
    • Phagocytic disorder, excluding chronic granulomatous disease
  • Diabetes mellitus
  • Generalized malignancy*
  • HIV infection*
  • Hodgkin disease*
  • Iatrogenic immunosuppression, including long-term systemic corticosteroids and radiation therapy*
  • Leukemia*
  • Lymphoma*
  • Multiple myeloma*
  • Nephrotic syndrome*
  • Sickle cell disease or other hemoglobinopathies*
  • Solid organ transplant*

* An immunocompromising condition

For those who have not previously received any pneumococcal vaccine†, CDC recommends you:

  • Give 1 dose of PCV15 or PCV20.
    • If PCV15 is used, this should be followed by a dose of PPSV23 at least one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.
    • If PCV20 is used, a dose of PPSV23 is NOT indicated.

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

For those who have only received PPSV23, CDC recommends you:

  • Give 1 dose of PCV15 or PCV20.
    • The PCV15 or PCV20 dose should be administered at least 1 year after the most recent PPSV23 vaccination.
    • Regardless of if PCV15 or PCV20 is given, an additional dose of PPSV23 is not recommended since they already received it.

For those who have only received PCV13, CDC recommends you either:

  • Give 1 dose of PCV20 at least 1 year after PCV13.

or

  • Give 1 dose of PPSV23; the minimum interval between the PCV13 and PPSV23 doses will vary based on their specific risk factor.
    • Immunocompromising condition: At least 8 weeks after PCV13
      These patients could receive up to two additional doses of PPSV23 in their lifetime. The second dose of PPSV23 should be administered at least 5 years after the first dose of PPSV23. If a patient is aged 65 years or older when the second dose is given, then a third dose is not indicated.
      If a patient is younger than 65 years when the second PPSV23 dose is given, then review pneumococcal vaccine recommendations again when the patient turns 65 years old.
    • Cochlear implant or cerebrospinal fluid leak: At least 8 weeks after PCV13
      Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
    • Other chronic health condition: Adults with a chronic medical condition (other than an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak) were previously not recommended to receive PCV13; however, if they received it then they should wait at least 1 year before receiving PPSV23
      Review pneumococcal vaccine recommendations again when the patient turns 65 years old.

For those who have received PCV13 and 1 dose of PPSV23, CDC recommends you either:

  • Give 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine.

or

  • Give a second dose of PPSV23 at least 8 weeks after PCV13 and 5 years after PPSV23 if they have an immunocompromising condition. Otherwise, no vaccines are recommended at this time for patients with any of the other conditions or risk factors listed above.
    • Review pneumococcal vaccine recommendations again when these patients turn 65 years old.

See Examples: Complete pneumococcal vaccine schedules for adults for a visual illustration of these vaccine options.

Adults 65 Years or Older

CDC recommends pneumococcal vaccination for all adults 65 years or older. The tables below provide detailed information.

For adults 65 years or older who have not previously received any pneumococcal vaccine†, CDC recommends you:

  • Give 1 dose of PCV15 or PCV20.
    • If PCV15 is used, this should be followed by a dose of PPSV23 at least 1 year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.
    • If PCV20 is used, a dose of PPSV23 is NOT indicated.

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

For adults 65 years or older who have only received PPSV23, CDC recommends you:

  • Give 1 dose of PCV15 or PCV20.
    • The PCV15 or PCV20 dose should be administered at least 1 year after the most recent PPSV23 vaccination.
    • Regardless of if PCV15 or PCV20 is given, an additional dose of PPSV23 is not recommended since they already received it.

For adults 65 years or older who have only received PCV13, CDC recommends you either:

  • Give 1 dose of PCV20 at least 1 year after PCV13.

or

  • Give 1 dose of PPSV23 at least 1 year after PCV13.
    • The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.

For adults 65 years or older who have received PCV13 at any age and PPSV23 before age 65 years, CDC recommends you either:

  • Give 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine.

or

  • Give 1 dose of PPSV23 at least 1 year after PCV13 dose and at least 5 years after the last PPSV23 dose.
    • The minimum interval (8 weeks since last PCV13 dose and 5 years since last PPSV23 dose) is recommended in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.

See Examples: Complete pneumococcal vaccine schedules for adults for a visual illustration of these vaccine options.

For adults 65 years or older who have received PCV13 at any age and PPSV23 at or after age 65 years, CDC recommends:

  • Shared clinical decision-making on whether to administer PCV20.
    • If the vaccine provider and patient decide PCV20 is appropriate, the dose of PCV20 should be administered at least 5 years after the last pneumococcal vaccine.

See a job-aid on Shared clinical decision-making: Pneumococcal vaccination [1 page] for additional guidance.

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