Standard Pneumococcal Vaccine Recommendations for Children
All healthy children aged 2–59 months should receive a 4-dose series of PCV13 (or the newer PCV15/PCV20 where available) at ages 2,4,6, and 12–15 months, while children with high-risk medical conditions require additional doses and PPSV23 vaccination starting at age 2 years. 1
Routine Schedule for Healthy Children
Infants Starting at 2 Months (No Prior Vaccination)
- Primary series: 3 doses of PCV13 at 2,4, and 6 months
- Minimum 4-week interval between doses for infants <1 year
- Can start as early as 6 weeks of age
- Booster dose: At 12–15 months, at least 8 weeks after the third dose 1
Late Starters (7–11 Months, Unvaccinated)
- 3 total doses needed:
- First 2 doses: 4 weeks apart minimum
- Third dose: At 12–15 months, ≥8 weeks after second dose 1
Late Starters (12–23 Months, Unvaccinated)
- 2 doses, ≥8 weeks apart 1
Late Starters (24–59 Months, Healthy Children)
- Single dose of PCV13 1
Important note: Routine PCV13 is not recommended for healthy children ≥5 years 1
High-Risk Children (Extended Recommendations)
Children 24–71 Months with Underlying Medical Conditions
High-risk conditions include 1:
- Immunocompromising conditions (HIV, malignancy, immunosuppressive therapy)
- Anatomic/functional asplenia (including sickle cell disease)
- Chronic heart/lung disease
- Diabetes mellitus
- Cerebrospinal fluid leaks
- Cochlear implants
- Chronic renal failure/nephrotic syndrome
PCV13 dosing for high-risk children:
- If unvaccinated or <3 prior doses: 2 doses of PCV13, ≥8 weeks apart
- If 3 prior doses: 1 dose of PCV13
- If completed 4-dose PCV7 series: 1 supplemental PCV13 dose 1
PPSV23 Administration (Age ≥2 Years, High-Risk Only)
After completing PCV13 series, high-risk children aged ≥2 years should receive PPSV23:
- Administer ≥8 weeks after the most recent PCV13 dose 1
- Second PPSV23 dose: Give 5 years after first PPSV23 for children with:
- Anatomic/functional asplenia (including sickle cell disease)
- HIV infection
- Other immunocompromising conditions
- Maximum 2 PPSV23 doses total 1
Children 6–18 Years with Specific High-Risk Conditions
Single dose of PCV13 may be given to previously unvaccinated children aged 6–18 years with 1, 2:
- Anatomic/functional asplenia (including sickle cell disease)
- Immunocompromising conditions (HIV infection, malignancy)
- Cochlear implants
- Cerebrospinal fluid leaks
Sequence for PPSV23-naïve high-risk children 6–18 years 2:
- PCV13 first
- PPSV23 ≥8 weeks later
- Second PPSV23 dose 5 years after first (for asplenia, HIV, immunocompromising conditions)
Critical Timing Considerations
Elective Surgery/Immunosuppressive Therapy
- Complete PCV13 and/or PPSV23 at least 2 weeks before:
- Elective splenectomy
- Cochlear implant placement
- Initiation of immunocompromising therapy 1
Premature Infants
- Use chronologic age (not corrected age) for vaccination timing
- Administer concurrent with other routine vaccinations if medically stable 1
Interrupted Schedules
- Do not restart series or add extra doses
- Simply continue from where the child left off 1
Common Pitfalls to Avoid
Hyporesponsiveness concern: Avoid giving PPSV23 before PCV13 in children, as polysaccharide vaccines may induce hyporesponsiveness to subsequent conjugate vaccines 1
Minimum intervals: For children <1 year, minimum interval is 4 weeks; for children ≥1 year, minimum interval is 8 weeks 1
High-risk identification: Many providers miss children with chronic conditions who qualify for extended vaccination—systematically screen for immunocompromising conditions, asplenia, cochlear implants, and CSF leaks 1
PPSV23 is NOT routine: PPSV23 is only for high-risk children ≥2 years, not part of routine childhood immunization 3
Updated vaccines: As of 2024, PCV20 has been added to recommendations in some jurisdictions, and PCV13 may be replaced—check current formulary 3