Pneumococcal Conjugate Vaccine (PCV13) Immunization Schedule
All healthy children should receive a 4-dose series of PCV13 at ages 2,4,6, and 12-15 months, with catch-up vaccination provided for unvaccinated or incompletely vaccinated children through age 59 months (71 months for those with underlying medical conditions). 1
Routine Vaccination Schedule
Infants and Toddlers (Starting at 2 months)
- Dose 1: 2 months (may start as early as 6 weeks)
- Dose 2: 4 months (minimum 4-week interval from dose 1)
- Dose 3: 6 months (minimum 4-week interval from dose 2)
- Dose 4: 12-15 months (minimum 8-week interval from dose 3) 1, 2
The minimum interval between doses for infants <12 months is 4 weeks; for children ≥12 months, it is 8 weeks 1.
Catch-Up Vaccination Schedules
Children 7-11 Months (Previously Unvaccinated)
- 3 total doses: 2 doses separated by 4-8 weeks, then a third dose at 12-15 months (≥8 weeks after dose 2) 1
Children 12-23 Months (Previously Unvaccinated)
- 2 doses separated by ≥8 weeks 1
Healthy Children 24-59 Months (Previously Unvaccinated or Incomplete Schedule)
- 1 dose of PCV13, administered ≥8 weeks after the most recent dose 1
Children 24-71 Months with Underlying Medical Conditions
For incomplete schedule (<3 doses before age 24 months):
- 2 doses of PCV13, with first dose ≥8 weeks after most recent dose and second dose ≥8 weeks later 1
For incomplete schedule (3 doses before age 24 months):
- 1 dose of PCV13, ≥8 weeks after most recent dose 1
Underlying medical conditions requiring enhanced vaccination include: chronic heart/lung disease, diabetes, cerebrospinal fluid leaks, cochlear implants, sickle cell disease, asplenia, HIV infection, chronic renal failure, nephrotic syndrome, immunocompromising conditions, and malignancy 1.
Transitioning from PCV7 to PCV13
Children Who Received Complete PCV7 Series
- All healthy children aged 14-59 months: 1 supplemental dose of PCV13, ≥8 weeks after last PCV7 dose 1
- Children with underlying medical conditions through 71 months: 1 supplemental dose of PCV13, ≥8 weeks after last PCV7 or PPSV23 dose 1
Children with Incomplete PCV7 Series
- Complete the series with PCV13 according to age-appropriate catch-up schedules above 1
Important caveat: Children aged 12-23 months who received 2-3 doses of PCV7 before age 12 months and at least 1 dose of PCV13 at age ≥12 months require no additional PCV13 doses 1.
High-Risk Children 6-18 Years
A single dose of PCV13 may be administered to children aged 6-18 years with increased risk for invasive pneumococcal disease, including those with:
- Anatomic or functional asplenia (including sickle cell disease)
- Immunocompromising conditions (HIV infection)
- Cochlear implants
- Cerebrospinal fluid leaks 1
This applies regardless of previous PCV7 or PPSV23 vaccination. Routine PCV13 is not recommended for healthy children ≥5 years 1.
PPSV23 Administration for High-Risk Children
Children ≥2 years with underlying medical conditions should receive PPSV23 after completing all recommended PCV13 doses:
- Administer PPSV23 at age ≥2 years and ≥8 weeks after the most recent PCV13 dose 1
- A second dose of PPSV23 is recommended 5 years after the first dose for children with anatomic/functional asplenia, sickle cell disease, HIV infection, or other immunocompromising conditions 1
- Maximum of 2 PPSV23 doses recommended 1
Influenza Vaccination Schedule
All children aged ≥6 months should receive annual influenza vaccination, with children aged ≤8 years receiving influenza vaccine for the first time requiring 2 doses separated by at least 4 weeks. 3, 4
Routine Annual Vaccination
Children 6-35 Months
- Dose: 0.25 mL of trivalent inactivated influenza vaccine (TIV)
- First-time recipients ≤8 years: 2 doses separated by ≥4 weeks 3
Children ≥3 Years
- Dose: 0.5 mL of TIV
- First-time recipients ≤8 years: 2 doses separated by ≥4 weeks 3
Alternative for Healthy Persons 5-49 Years
- Live attenuated influenza vaccine (LAIV) administered intranasally is an acceptable alternative to TIV 3
Priority Groups for Influenza Vaccination
High-priority groups include children with:
- Asthma
- Cardiac disease
- Sickle cell disease
- HIV infection
- Diabetes
- Other chronic conditions 3
Additionally, healthy children aged 6-23 months and close contacts of high-risk individuals are recommended to receive influenza vaccine due to substantially increased risk of influenza-related hospitalizations 3.
Recurrent Acute Otitis Media (rAOM) Management
For children with recurrent acute otitis media, focus on risk factor reduction and ensure completion of pneumococcal conjugate and annual influenza vaccination; pneumococcal antibody testing is not routinely indicated, and long-term prophylactic antibiotics are discouraged. 5
Risk Factor Reduction
- Reduce or eliminate daycare attendance when feasible
- Eliminate tobacco smoke exposure
- Encourage breastfeeding 5
Immunoprophylaxis
- Ensure completion of age-appropriate PCV13 series (as detailed above)
- Annual influenza vaccination starting at 6 months of age 5
Evidence shows PCV vaccination demonstrates approximately 60% vaccine efficacy against vaccine-serotype pneumococcal otitis media across multiple trials, with greater efficacy against recurrent AOM and tympanostomy-tube placement, suggesting early vaccination prevents subsequent complicated otitis media episodes 6.
Not Recommended
- Long-term prophylactic antibiotics are discouraged for rAOM 5
- Pneumococcal antibody testing is not routinely indicated for management of recurrent AOM
Surgical Intervention Considerations
Tympanostomy tube placement should be considered based on:
- Bilaterality of disease
- Duration >3 months
- Hearing status (varies by guideline: >25-40 dB HL in better ear)
- Effect on child's well-being, behavior, and development
- Parental involvement in decision-making 5
Important note: Medical treatment beyond vaccination is generally discouraged for otitis media with effusion, with watchful waiting recommended initially unless the child belongs to a high-risk group 5.