What are the guidelines for pneumonia vaccination, including recommended vaccines, dosages, and schedules for different age groups and health conditions?

Pneumococcal Vaccination Guidelines

All infants should receive PCV13 (or PCV20) as a 4-dose series at 2,4,6, and 12-15 months of age, while adults ≥65 years should receive a single dose of PCV20. 1, 2

Pediatric Vaccination Schedule

Infants 2-6 Months (No Prior Vaccination)

• Administer 3 primary doses of PCV13 at 2,4, and 6 months with intervals of approximately 8 weeks (minimum 4 weeks between doses) 3
• Give the fourth booster dose at 12-15 months, at least 8 weeks after the third dose 3, 2
• The first dose can be given as early as 6 weeks of age 3
• Premature infants (<37 weeks gestation) should receive PCV13 at the recommended chronologic age, not adjusted age 3

Catch-Up Schedules for Unvaccinated Children

Infants 7-11 Months:

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

Children 12-23 Months:

• Administer 2 doses at least 8 weeks apart 3, 2

Healthy Children 24-59 Months:

• Give a single dose of PCV13 3, 2

Children 24-71 Months with High-Risk Conditions:

• Administer 2 doses of PCV13 at least 8 weeks apart 3, 2
• High-risk conditions include functional/anatomic asplenia, immunocompromising conditions, CSF leaks, cochlear implants, chronic heart/lung disease, diabetes, and HIV infection 3

Children with Incomplete PCV7/PCV13 Series

• Children <24 months who received ≥1 dose of PCV7 should complete the series with PCV13 3
• Children 12-23 months who received 3 doses of PCV7 before 12 months need only 1 dose of PCV13 at least 8 weeks after the last PCV7 dose 3
• Interruption of the schedule does not require restarting the series or adding extra doses 3

PPSV23 in High-Risk Children

• Children ≥2 years with high-risk conditions should receive PPSV23 at least 8 weeks after completing PCV13 series 3
• A second dose of PPSV23 should be given 5 years after the first dose in children with immunocompromising conditions or asplenia 3

Adult Vaccination Schedule

Adults ≥65 Years

No Prior Pneumococcal Vaccination:

• Give a single dose of PCV20 1, 4
• Alternative: PCV15 followed by PPSV23 at least 1 year later 2

Previous PPSV23 Only:

• Administer PCV20 at least 1 year after the last PPSV23 dose 1, 4

Adults 19-64 Years with High-Risk Conditions

Immunocompromising Conditions, CSF Leaks, or Cochlear Implants:

• Give a single dose of PCV20 1, 4
• Alternative: PCV15 followed by PPSV23 at least 8 weeks later 2

Chronic Medical Conditions (heart disease, lung disease, diabetes, alcoholism, smoking):

• Administer a single dose of PCV20 4

Hematopoietic Stem Cell Transplant Recipients

• Give 3 doses of PCV20, 4 weeks apart, starting 3-6 months after HSCT 1, 2, 4
• Administer a fourth dose at least 6 months after the third dose OR at least 12 months after HSCT, whichever is later 1, 2, 4

Critical Clinical Considerations

Vaccine Administration

• PCV vaccines can be given concurrently with other age-appropriate vaccines at different anatomic sites 2, 4
• Administer intramuscularly in the anterolateral thigh for infants or deltoid for older children and adults 5

Common Pitfalls to Avoid

• Always verify vaccination history before administering pneumococcal vaccines - incorrect timing or unnecessary doses are common errors 1, 4
• Do not withhold vaccination due to lack of records; use patient/parent verbal history to guide decisions 1
• Respect minimum intervals: 4 weeks between infant primary doses, 8 weeks for catch-up and booster doses 3, 2
• Do not give PPSV23 before PCV13 in children, as this may cause hyporesponsiveness to subsequent PCV doses 3

Special Populations

• Monitor premature infants for apnea following vaccination, particularly if they have a history of respiratory immaturity 2, 5
• Patients on immunosuppressive therapy may have reduced vaccine response; timing of vaccination relative to therapy should be optimized when possible 5
• For patients who received PCV15 but not PPSV23, one dose of PCV20 may substitute if PPSV23 is unavailable 1, 4

Adverse Events

• Most common reactions are mild and self-limited: injection site pain, erythema, swelling (resolve within 48 hours) 3
• Fever ≥38°C occurs in 15-25% of children within 2 days of vaccination 6
• Severe allergic reactions are rare but require immediate management capability 5