Pneumococcal Immunization for a 4-Month-Old
A 4-month-old infant should receive the second dose of PCV13 (13-valent pneumococcal conjugate vaccine) as part of the routine 4-dose series administered at 2,4,6, and 12-15 months of age. 1
Vaccination Schedule
For infants aged 2-6 months with no previous pneumococcal vaccination:
- Primary series consists of 3 doses of PCV13 given at approximately 2,4, and 6 months of age 1
- Minimum interval between doses is 4 weeks, though approximately 8 weeks is recommended 1
- Fourth (booster) dose is administered at 12-15 months, at least 8 weeks after the third dose 1
Key Clinical Points
For a 4-month-old presenting for vaccination:
- If this is the first pneumococcal vaccine dose (late start), the infant should receive PCV13 and continue with doses at 6 months and 12-15 months 1
- If the infant received the first dose at 2 months, administer the second dose now, with subsequent doses at 6 months and 12-15 months 1
- PCV13 should be administered concurrently with other routine vaccinations at separate injection sites 1
Special Populations
Premature infants (<37 weeks gestation) who are medically stable should receive PCV13 at the recommended chronologic age (not corrected age), concurrent with other routine vaccinations 1
Safety Profile
- Local reactions (erythema, induration, tenderness) occur in approximately 10-20% of recipients 1
- Fever ≥38°C occurs in 15-25% within the first 2 days post-vaccination 1
- Systemic reactions (irritability, decreased appetite, sleep changes) are generally mild and comparable to PCV7 1, 2
- No serious adverse events have been causally linked to PCV13 in clinical trials involving approximately 15,000 doses 1
Common Pitfalls to Avoid
- Do not delay vaccination if the infant missed the 2-month dose—start the series now and continue on schedule 1
- Do not restart the series if there are interruptions in the vaccination schedule; simply continue where left off 1
- Do not use PPSV23 (23-valent polysaccharide vaccine) in this age group—it is only indicated for children ≥2 years with specific high-risk conditions 1