How often is pneumococcal (pneumonia) vaccination recommended?

Pneumococcal Vaccination Recommendations

Pneumococcal vaccination is recommended as a 4-dose series for children (at 2,4,6, and 12-15 months) and as a single dose of PCV20 alone or PCV15 followed by PPSV23 for adults aged ≥65 years and those with certain underlying conditions. 1

Recommended Vaccination Schedules

For Children

• Standard childhood schedule: 4 doses of pneumococcal conjugate vaccine (PCV) administered at:

  • 2 months
  • 4 months
  • 6 months
  • 12-15 months 1, 2

• Catch-up vaccination:

  • Children 7-23 months who missed previous doses: reduced number of doses
  • Unvaccinated children 12-23 months: single dose of PCV 3
  • Children 24-59 months with high-risk conditions: two doses of PCV 4

For Adults

• Adults aged ≥65 years and adults 19-64 years with certain underlying conditions:

  • Option A: Single dose of PCV20 alone
  • Option B: PCV15 followed by PPSV23 at least 1 year later for immunocompetent adults or 8 weeks later for immunocompromised adults 1

• Revaccination guidance:

  • If previously received PPSV23 only: Administer PCV20 or PCV15 at least 1 year after the last PPSV23 dose
  • If previously received PCV13 only: Administer PCV20 at least 1 year after PCV13, or PPSV23 at least 1 year after PCV13 1
  • Routine revaccination of immunocompetent persons previously vaccinated with a 23-valent vaccine is not recommended 5

Special Populations

Immunocompromised Individuals

• High-risk conditions include:

  • Congenital or acquired asplenia
  • Sickle cell disease
  • Chronic renal failure
  • HIV infection
  • Hematologic malignancies
  • Solid organ transplant
  • Other immunodeficiencies 1

• For hematopoietic stem cell transplant (HSCT) recipients:

  • Option A: 3 doses of PCV20, 4 weeks apart starting 3-6 months after HSCT, with a fourth dose ≥6 months after the third dose or ≥12 months after HSCT (whichever is later)
  • Option B: 3 doses of PCV15, 4 weeks apart starting 3-6 months after HSCT, followed by PPSV23 ≥12 months after HSCT if no chronic GVHD 3, 1

Clinical Considerations

• Timing with other procedures: When planning elective splenectomy or immunosuppressive therapy, complete pneumococcal vaccination at least 2 weeks before surgery or initiation of therapy 1

• Interval between vaccines:

  • For sequential vaccines (PCV15 followed by PPSV23): Maintain minimum intervals of at least 8 weeks between PCV15 and PPSV23 for immunocompromised adults and at least 1 year for immunocompetent adults with risk conditions 1

• Effectiveness of partial vaccination: While complete vaccination according to licensed schedules provides optimal protection, evidence shows that even a single dose of PCV provides protection against vaccine-type invasive pneumococcal disease, especially when administered after age 12 months 6

• Documentation: Clearly document which pneumococcal vaccines have been administered to guide future vaccination decisions 1

Common Pitfalls to Avoid

1. Missing high-risk individuals: Actively identify patients with chronic conditions who qualify for vaccination before age 65 1

2. Incorrect intervals between vaccines: Ensure proper timing between PCV and PPSV23, with a minimum 1-year interval for adults or 8-week interval for immunocompromised adults 1

3. Incomplete vaccination series: Complete the full recommended series for maximum protection, especially for HSCT recipients who require multiple doses 1

4. Discontinuing antibiotic prophylaxis: For children with functional or anatomic asplenia, including sickle cell disease, continue antibiotic prophylaxis until age 5 years even after pneumococcal vaccination 4

5. Assuming vaccination eliminates need for clinical vigilance: Despite vaccination, maintain awareness of possible pneumococcal disease, especially in incompletely vaccinated children 3