Recommended Pneumococcal Vaccine Schedule
The recommended pneumococcal vaccine schedule varies by age group, with PCV20 now being the preferred single-dose option for adults aged ≥19 years, while children under 2 years should receive PCV13 in a 4-dose series at 2,4,6, and 12-15 months of age. 1
Pneumococcal Vaccination for Children
Routine Schedule for Healthy Infants and Children
- For infants starting at 2-6 months: 3 doses of PCV13 given 8 weeks apart, with a fourth dose at 12-15 months of age 1
- For infants starting at 7-11 months: 2 doses of PCV13 given 8 weeks apart, with a third dose at 12-15 months 1
- For children 12-23 months: 2 doses of PCV13 given at least 8 weeks apart 1
- For healthy children 24-59 months: 1 dose of PCV13 1
Schedule for Children with Underlying Medical Conditions
- Children 24-71 months with underlying medical conditions (including immunocompromising conditions, CSF leaks, or cochlear implants) who have received <3 doses of PCV before age 24 months should receive 2 doses of PCV13 1
- Children with underlying conditions who have received 3 doses of PCV should receive a single supplemental dose of PCV13 through age 71 months 1
Catch-up Vaccination
- Children who previously received PCV7 should complete their series with PCV13 1
- For children who received 4 doses of PCV7, a single supplemental dose of PCV13 is recommended for all children 14-59 months, and for those with underlying conditions through 71 months 1
- The minimum interval between doses is 8 weeks for children ≥12 months, and 4 weeks for children <12 months 1
Pneumococcal Vaccination for Adults
Adults Aged ≥65 Years
- A single dose of PCV20 is recommended for adults aged ≥65 years who have not previously received a pneumococcal conjugate vaccine 1, 2
- Alternatively, a single dose of PCV15 followed by PPSV23 at least 1 year later can be given 1, 3
- For those who previously received PPSV23 only, a single dose of PCV20 is recommended at least 1 year after the last PPSV23 dose 1, 2
Adults Aged 19-64 Years with Risk Factors
- For adults with immunocompromising conditions, CSF leaks, or cochlear implants: a single dose of PCV20 or PCV15 followed by PPSV23 at least 8 weeks later 1, 3
- For adults with chronic medical conditions: a single dose of PCV20 or PCV15 followed by PPSV23 at least 1 year later 3
Special Populations
- Hematopoietic stem cell transplant recipients: 3 doses of PCV20 given 4 weeks apart starting 3-6 months after HSCT, followed by a fourth dose at least 6 months after the third dose or at least 12 months after HSCT, whichever is later 1, 2
Important Clinical Considerations
Timing and Administration
- PCV vaccines can be administered concurrently with other age-appropriate vaccines at different anatomic sites 2
- No routine revaccination is needed for most adults after completing the recommended pneumococcal vaccine series 3
- Minimum intervals between vaccines must be respected to ensure optimal immune response 3
Common Pitfalls to Avoid
- Failing to check the patient's prior pneumococcal vaccination history can lead to unnecessary doses or incorrect schedules 2
- Not providing the supplemental PCV13 dose to children who completed PCV7 series may leave them vulnerable to additional serotypes 4
- Withholding vaccination due to lack of documentation is not recommended; the patient's verbal history should be used when records are unavailable 2
Safety Considerations
- PCV vaccines are generally well-tolerated with mostly mild, self-limited injection site reactions 1
- Fever ≥38°C occurs in approximately 15-25% of children within the first two days following vaccination 5
- Apnea following vaccination has been observed in some premature infants; vaccination decisions should consider the individual infant's medical status 1