What pneumococcal vaccines should an asplenic pediatric patient receive, including Prevnar 13 (Pneumococcal conjugate vaccine) and Pneumovax 23 (Pneumococcal polysaccharide vaccine)?

Pneumococcal Vaccination for Asplenic Pediatric Patients

Asplenic children should receive both PCV13 (Prevnar 13) and PPSV23 (Pneumovax 23) vaccines in a sequential schedule, with PCV13 administered first followed by PPSV23 at least 8 weeks later, starting at age 2 years or older. 1

Age-Specific PCV13 Dosing for Asplenic Children

Infants 2-6 Months

• Administer the standard 4-dose series at 2,4,6, and 12-15 months of age 1, 2
• Minimum interval between primary series doses is 4 weeks 1
• The booster dose at 12-15 months must be given at least 8 weeks after the third dose 1

Infants 7-11 Months (Previously Unvaccinated)

• Give 3 total doses: 2 doses at least 4 weeks apart, followed by a third dose at 12-15 months (at least 8 weeks after the second dose) 1, 2

Children 12-23 Months (Previously Unvaccinated)

• Administer 2 doses of PCV13 with at least 8 weeks between doses 1

Children 24-71 Months with Asplenia

• If unvaccinated or received <3 doses before age 24 months: Give 2 doses of PCV13 with at least 8 weeks between doses 1
• If received 3 doses of PCV before age 24 months: Give 1 dose of PCV13 at least 8 weeks after the most recent dose 1
• If completed 4-dose PCV7 series: Give 1 supplemental dose of PCV13 at least 8 weeks after the most recent dose 1

Children 6-18 Years with Asplenia

• A single dose of PCV13 is recommended for those who have not received PCV13 previously, regardless of prior PCV7 or PPSV23 vaccination 1, 2
• This applies specifically to children with anatomic or functional asplenia 1

PPSV23 Administration After PCV13

All asplenic children aged ≥2 years should receive PPSV23 after completing their recommended PCV13 doses. 1

Timing and Dosing

• Administer 1 dose of PPSV23 at age ≥2 years and at least 8 weeks after the most recent PCV13 dose 1, 2
• For children 24-71 months with asplenia who received <3 doses of PCV before age 24 months: complete the 2-dose PCV13 series first, then give PPSV23 at least 8 weeks later 1

Critical Timing Consideration

• If the child previously received PPSV23 before PCV13: Administer PCV13 at least 8 weeks after the most recent PPSV23 dose 1, 2
• This reversal scenario is important because research shows that prior PPSV23 can blunt the immune response to subsequent PCV13, particularly affecting memory B-cell responses 3

Evidence-Based Rationale

The sequential PCV13-then-PPSV23 strategy is superior to PPSV23 alone in asplenic children. Research demonstrates that patients who received only PPSV23 had significantly lower antibody concentrations against serotypes 1, 6A, 7F, and 19A compared to those who received at least one PCV13 vaccination 4. Additionally, PCV13 recipients showed significantly higher opsonophagocytic activity against serotypes 3,5, and 19A 4.

PCV13 revaccination in asplenic children previously vaccinated with PPSV23 is both safe and immunogenic, providing appropriate booster responses in this high-risk population 5. The conjugate vaccine induces T-dependent immune responses that are more durable than the T-independent responses from polysaccharide vaccines 3.

Special Circumstances

Elective Splenectomy

• Complete all PCV13 vaccinations at least 2 weeks before the planned splenectomy 2
• This allows optimal antibody development before the increased infection risk

Children with Incomplete Vaccination History

• Do not restart the series—simply continue from where the child left off 1
• Use the age-appropriate catch-up schedule based on current age and number of previous doses 1

Common Pitfalls to Avoid

• Do not give PPSV23 before PCV13 in vaccine-naive asplenic children, as this can impair the subsequent response to PCV13 3
• Do not skip the PPSV23 after completing PCV13, as it provides coverage for additional serotypes not included in PCV13 1
• Do not use intervals shorter than 8 weeks between PCV13 and PPSV23, as this is the minimum recommended interval 1, 2
• Do not assume healthy children's schedules apply—asplenic children require additional doses beyond the routine 4-dose infant series if they are older than 24 months 1