What is the recommended pneumococcal vaccine (PCV - Pneumococcal Conjugate Vaccine) and PPSV (Pneumococcal Polysaccharide Vaccine) schedule for pediatric patients?

Pediatric Pneumococcal Vaccination Schedule

Routine Schedule for Healthy Children

All healthy infants should receive a 4-dose series of PCV13 (pneumococcal conjugate vaccine) at 2,4,6, and 12-15 months of age, with no additional pneumococcal vaccines needed after completing this series unless high-risk conditions develop. 1, 2

Standard Dosing Schedule

• Primary series: Administer PCV13 at 2,4, and 6 months of age 2, 3
• Booster dose: Give the fourth dose at 12-15 months, at least 8 weeks after the third dose 1, 2
• Minimum intervals: 4 weeks between doses for infants <1 year; 8 weeks between doses for children ≥12 months 1

Catch-Up Vaccination by Age

For children 7-11 months (unvaccinated):

• Give 2 doses 8 weeks apart, then a third dose at 12-15 months 1

For children 12-23 months (unvaccinated):

• Give 2 doses at least 8 weeks apart 1

For healthy children 24-59 months (unvaccinated or incomplete schedule):

• Give 1 dose of PCV13 at least 8 weeks after the most recent dose 1

Critical point: Never restart the series if doses are delayed—simply continue where you left off 2, 3

High-Risk Children Requiring Additional Doses

Children 24-71 Months with Underlying Medical Conditions

Children with the following conditions require additional PCV13 doses and subsequent PPSV23: 1

• Immunocompromising conditions (HIV infection, chronic renal failure, nephrotic syndrome, immunosuppressive therapy, malignancy)
• Functional or anatomic asplenia (including sickle cell disease)
• Cochlear implants
• Cerebrospinal fluid leaks

Dosing for high-risk children 24-71 months:

• If <3 doses received before age 24 months: Give 2 doses of PCV13, 8 weeks apart 1
• If 3 doses received 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

PPSV23 Administration for High-Risk Children

After completing all recommended PCV13 doses, high-risk children aged 2-18 years should receive PPSV23 at least 8 weeks after the final PCV13 dose. 1, 3

Older High-Risk Children (6-18 Years)

A single dose of PCV13 may be given to children aged 6-18 years with high-risk conditions who have not previously received PCV13, regardless of prior PCV7 or PPSV23 vaccination. 1

Special Populations

Premature Infants

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. 2, 3

Children Previously Vaccinated with PCV7

All children who received any doses of PCV7 should complete their series with PCV13. 3

• Children 14-59 months who completed a 4-dose PCV7 series: Give 1 supplemental dose of PCV13 at least 8 weeks after the last PCV7 dose 1
• Children 12-23 months who received 2-3 doses of PCV7 before 12 months and at least 1 dose of PCV13 at ≥12 months: No additional doses needed 1

Duration of Protection

Healthy children who complete the 4-dose PCV13 series maintain protection throughout childhood without requiring booster doses after age 5 years. 4

• The standard series provides durable protection with 97.4% efficacy against invasive pneumococcal disease caused by vaccine serotypes 4
• No routine booster doses are recommended beyond the toddler dose at 12-15 months for healthy children 4

Safety Profile

PCV13 is safe with only minor adverse events reported: 2

• Local reactions (redness, swelling, tenderness): 10-20% of recipients 2, 5
• Fever ≥38°C: 15-25% within first 2 days post-vaccination 2, 5
• No serious adverse events causally linked to PCV13 in clinical trials 2

Critical Pitfalls to Avoid

• Do not use PPSV23 in children <2 years of age—it is only indicated for children ≥2 years with specific high-risk conditions 2, 3
• Do not delay vaccination if doses are missed—start or continue the series immediately without restarting 2, 3
• Do not give routine PCV13 to healthy children ≥5 years—it is not recommended for this age group 1
• Do not forget to administer PPSV23 to high-risk children after completing PCV13—this provides broader serotype coverage 1, 3