What is the recommended administration route and schedule for pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV)?

How to Administer Pneumococcal Vaccines

Pneumococcal vaccines are administered intramuscularly, with specific schedules based on age, vaccination history, and underlying medical conditions. 1, 2

Route of Administration

• Both PCV (pneumococcal conjugate vaccine) and PPSV23 (pneumococcal polysaccharide vaccine) are given via intramuscular injection. 2
• Each dose is 0.5 mL injected into the muscle using a sterile needle. 2
• The vaccine must be shaken vigorously until it forms a homogeneous white suspension before administration. 2

PCV Administration Schedule for Infants and Young Children

Routine Infant Series (Starting at 2 Months)

• Administer a 4-dose series at ages 2,4,6, and 12-15 months. 1, 3
• The minimum interval between the first three doses is 4 weeks. 1
• The fourth (booster) dose must be given at least 8 weeks after the third dose. 1, 3
• The first dose can be given as early as 6 weeks of age. 1

Catch-Up Schedule for Previously Unvaccinated Children

Ages 7-11 months:

• 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, 3

Ages 12-23 months:

• Give 2 doses with at least 8 weeks between doses. 1, 3

Ages 24-59 months (healthy children):

• Give 1 single dose. 1, 3

Ages 24-71 months (children with underlying medical conditions):

• Give 2 doses with at least 8 weeks between doses. 1, 3
• Underlying conditions include immunocompromising conditions, anatomic/functional asplenia, sickle cell disease, HIV infection, chronic heart or lung disease, cerebrospinal fluid leaks, and cochlear implants. 1

Transitioning from PCV7 to PCV13

• All children who received any doses of PCV7 should complete their series with PCV13. 1
• Children aged 14-59 months who completed a full PCV7 series should receive 1 supplemental dose of PCV13 at least 8 weeks after their last PCV7 dose. 1
• For children with underlying medical conditions, this supplemental dose is recommended through age 71 months. 1

PPSV23 Administration After PCV in High-Risk Children

Sequential vaccination is required for children aged ≥2 years with underlying medical conditions:

• Complete all recommended PCV13 doses first. 1
• Give PPSV23 at least 8 weeks after the most recent PCV13 dose. 1, 4
• A second dose of PPSV23 is recommended 5 years after the first dose for children with anatomic/functional asplenia, sickle cell disease, HIV infection, or other immunocompromising conditions. 1
• No more than 2 doses of PPSV23 are recommended. 1

Critical Timing for Elective Procedures

• When elective splenectomy, immunocompromising therapy, or cochlear implant placement is planned, complete PCV13 and/or PPSV23 vaccination at least 2 weeks before surgery or therapy initiation. 1, 3

Adult Vaccination Schedule

Adults aged ≥50 years:

• Administer a single dose of PCV20 as a one-time vaccination. 5, 6
• If PCV20 is unavailable, give PCV15 followed by PPSV23 at least 1 year later. 5

Adults who previously received only PPSV23:

• Give one dose of PCV20 at least 1 year after the last PPSV23 dose. 5

Adults aged 19-64 with chronic medical conditions or immunocompromising conditions:

• Administer a single dose of PCV20. 5
• Risk conditions include chronic heart, lung, or liver disease, diabetes mellitus, and immunocompromising conditions such as HIV. 5

Special Populations

Premature infants:

• Administer PCV13 at the recommended chronologic age (not corrected age) if the infant is medically stable. 1
• Monitor for apnea following intramuscular vaccination, as this has been observed in some premature infants. 1

Children aged 6-18 years with high-risk conditions:

• A single dose of PCV13 may be given to those who have not received PCV13 previously and have anatomic/functional asplenia, immunocompromising conditions, cochlear implants, or cerebrospinal fluid leaks. 1, 3

Hematopoietic stem cell transplant recipients:

• Administer 4 doses of PCV20. 5

Important Clinical Considerations

Contraindications:

• Do not administer to individuals with a history of severe allergic reaction (anaphylaxis) to any vaccine component or diphtheria toxoid. 2

Vaccination during acute illness:

• Vaccines can be given to persons with minor acute illness (diarrhea or mild upper respiratory infection with or without fever). 1
• Defer vaccination in persons with moderate or severe acute illness until the illness improves. 1

Common adverse reactions in children:

• Injection site reactions (pain/tenderness 48.8%, erythema 46.6%, swelling 35.3%), irritability (70%), drowsiness (59.2%), decreased appetite (38.7%), and fever (36.9%). 1

Common adverse reactions in adults:

• Pain at injection site (>70% in adults 18-59 years, >50% in adults ≥60 years), muscle pain (>50% in younger adults, >30% in older adults), fatigue (>40% in younger adults, >30% in older adults), and headache (>30% in younger adults, >20% in older adults). 2

Critical Pitfalls to Avoid

• Never give PPSV23 before PCV13 in vaccine-naive children, as this impairs subsequent response to PCV13. 4
• Do not restart the vaccination series if interrupted; simply continue from where the child left off using the age-appropriate catch-up schedule. 4
• Always wait at least 8 weeks between PCV13 and PPSV23 in children with high-risk conditions. 1, 4
• Do not routinely revaccinate healthy adults after completing the recommended schedule. 5