What is the recommended schedule for Pneumococcal (Streptococcus pneumoniae) vaccination?

From the Guidelines

The recommended schedule for Pneumococcal (Streptococcus pneumoniae) vaccination is to administer a single dose of PCV21, PCV20, or PCV15, with a subsequent dose of PPSV23 if necessary, based on the individual's age, health status, and previous vaccination history, as outlined in the most recent guidelines from the Advisory Committee on Immunization Practices 1.

Key Recommendations

• For adults aged ≥65 years, a single dose of PCV21, PCV20, or PCV15 is recommended, with a subsequent dose of PPSV23 if PCV15 is used, administered at least 1 year after the PCV15 dose 1.
• For adults aged 19-64 years with an immunocompromising condition, a CSF leak, or a cochlear implant, a single dose of PCV21, PCV20, or PCV15 is recommended, with a subsequent dose of PPSV23 if PCV15 is used, administered at least 8 weeks after the PCV15 dose 1.
• For adults aged 19-64 years with chronic medical conditions, a single dose of PCV21, PCV20, or PCV15 is recommended, with a subsequent dose of PPSV23 if PCV15 is used, administered at least 1 year after the PCV15 dose 1.

Vaccine Options

• PCV21: a 21-valent pneumococcal conjugate vaccine that provides protection against 21 serotypes of Streptococcus pneumoniae 1.
• PCV20: a 20-valent pneumococcal conjugate vaccine that provides protection against 20 serotypes of Streptococcus pneumoniae 1.
• PCV15: a 15-valent pneumococcal conjugate vaccine that provides protection against 15 serotypes of Streptococcus pneumoniae, often used in combination with PPSV23 1.
• PPSV23: a 23-valent pneumococcal polysaccharide vaccine that provides protection against 23 serotypes of Streptococcus pneumoniae, often used in combination with PCV15 1.

Important Considerations

• The choice of vaccine and schedule should be based on the individual's age, health status, and previous vaccination history, as well as the most recent guidelines from the Advisory Committee on Immunization Practices 1.
• Shared clinical decision-making is recommended for certain individuals, such as those who have completed the recommended vaccination series with both PCV13 and PPSV23, but have not yet received PCV21 or PCV20 1.

From the FDA Drug Label

2.3 Vaccination Schedule for Individuals 6 Weeks Through 15 Months of Age Administer Prevnar 20 as a 4-dose series at 2,4,6, and 12 through 15 months of age (and at least 2 months after the third dose). The first dose may be given as early as 6 weeks of age.

2.4 Catch-Up Vaccination Schedule for Unvaccinated Individuals 7 Months Through 17 Years of Age Individuals 7 months through 17 years of age who have never received a pneumococcal conjugate vaccine may receive Prevnar 20 according to the schedule in Table 1:

2.5 Catch-Up Vaccination Schedule for Individuals Previously Vaccinated With One or More Doses of a Lower Valency Pneumococcal Conjugate Vaccine Administer a single dose of Prevnar 20 to individuals 15 months through 17 years of age previously vaccinated with one or more doses of a lower valency pneumococcal conjugate vaccine The dose of Prevnar 20 should be administered at least 8 weeks after the last dose of the lower valency pneumococcal conjugate vaccine.

2.6 Vaccination Schedule for Individuals 18 Years of Age and Older Prevnar 20 is administered as a single dose.

The recommended schedule for Pneumococcal (Streptococcus pneumoniae) vaccination using Prevnar 20 is as follows:

• Infants 6 weeks through 15 months of age: 4-dose series at 2,4,6, and 12 through 15 months of age.
• Unvaccinated individuals 7 months through 17 years of age:
  • 7 through 11 months of age: 3 doses
  • 12 through 23 months of age: 2 doses
  • 24 months of age and above: 1 dose
• Individuals previously vaccinated with one or more doses of a lower valency pneumococcal conjugate vaccine (15 months through 17 years of age): single dose of Prevnar 20 at least 8 weeks after the last dose of the lower valency pneumococcal conjugate vaccine.
• Individuals 18 years of age and older: single dose of Prevnar 20 2

From the Research

Pneumococcal Vaccination Schedule

The recommended schedule for Pneumococcal (Streptococcus pneumoniae) vaccination varies by age group and risk group 3, 4.

• For children 23 months and younger, the heptavalent pneumococcal conjugate vaccine (PCV7) is recommended to be given concurrently with other recommended childhood vaccines at 2,4,6, and 12 to 15 months of age 4.
• For children 7 to 23 months old who have not received previous doses of PCV7, administration of a reduced number of doses is recommended 4.
• The 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) have been recommended for U.S. children, with risk-based recommendations on use of PPSV23 for persons aged 2-18 years with certain underlying medical conditions 3.
• The 15-valent pneumococcal conjugate vaccine (PCV15) has been approved for use in persons aged 6 weeks-17 years, and is recommended as an option for pneumococcal conjugate vaccination of persons aged <19 years according to currently recommended PCV13 dosing and schedules 3.

Dosing Schedules

Different dosing schedules have been evaluated for their effectiveness in preventing pneumococcal disease:

• A 2+1 schedule (one dose at 2 months old, one at 4 months old, and a booster dose at 12 months old) has been shown to be effective in reducing invasive pneumococcal disease (IPD) rates in children 5.
• A systematic review of studies found that all schedules, including 2+1,3+0, and 3+1, reduced clinical and radiologically confirmed pneumonia incidence, with no significant difference in disease impact among schedules 6.
• The effectiveness of reduced-dose schedules, such as 1p+1b and 2p+0b, has been found to be lower than that of the 2p+1b schedule in preventing vaccine-serotype pneumococcal colonization in children 7.