What is the recommended vaccination schedule for Prevnar 13 (pneumococcal conjugate vaccine) in adults and children with certain medical conditions?

Prevnar 13 Vaccination Schedule

For healthy children, administer Prevnar 13 as a 4-dose series at 2,4,6, and 12-15 months of age; for adults ≥65 years, PCV13 is no longer routinely recommended—instead use shared clinical decision-making unless they have immunocompromising conditions, CSF leak, or cochlear implant, in which case give one dose followed by PPSV23. 1

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Infant and Child Vaccination Schedule

Routine Infant Series (Starting at 2 Months)

• Administer 4 doses at ages 2,4,6, and 12-15 months with a minimum 4-week interval between the first three doses and at least 8 weeks between the third and fourth doses 2, 3
• The first dose may be given as early as 6 weeks of age 4

Catch-Up Schedules by Age

Children 7-11 months (unvaccinated):

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

Children 12-23 months (unvaccinated):

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

Healthy children 24-59 months:

• Give 1 dose if previously unvaccinated or with incomplete schedule 2, 3

Children 24-71 months with underlying medical conditions:

• If unvaccinated or received <3 doses: give 2 doses, at least 8 weeks apart 2, 3
• If received 3 doses: give 1 dose, at least 8 weeks after the most recent dose 2

Transitioning from PCV7 to PCV13

• All children aged 14-59 months who completed a PCV7 series should receive one supplemental dose of PCV13 at least 8 weeks after their last PCV7 dose 2
• For children with underlying medical conditions, this supplemental dose is recommended through age 71 months 2

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High-Risk Children and Adolescents

Children 6-18 Years with Specific Conditions

• Give a single dose of PCV13 if not previously received and the child has: 2, 3
  • Anatomic or functional asplenia (including sickle cell disease)
  • Immunocompromising conditions (including HIV infection)
  • Cochlear implant
  • Cerebrospinal fluid (CSF) leak

PPSV23 After PCV13 in High-Risk Children

• Children aged 2-18 years with underlying medical conditions should receive PPSV23 at least 8 weeks after completing PCV13 2, 3, 5
• Routine use of PCV13 is not recommended for healthy children ≥5 years 2

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Adult Vaccination Schedule

Adults ≥65 Years Without High-Risk Conditions

• PCV13 is no longer routinely recommended for all adults ≥65 years as of 2019 1, 6
• Use shared clinical decision-making to determine if PCV13 is appropriate for individuals without immunocompromising conditions, CSF leak, or cochlear implant 1
• Consider PCV13 for those at increased exposure risk (nursing home residents, areas with low pediatric PCV13 uptake, international travel to areas without pediatric PCV13 programs) 1
• All adults ≥65 years should receive PPSV23 regardless of PCV13 decision 1

Adults with High-Risk Conditions (Any Age ≥19 Years)

Mandatory PCV13 indications include: 1

• Immunocompromising conditions (congenital/acquired immunodeficiencies, HIV, malignancy, leukemia, lymphoma, Hodgkin disease, multiple myeloma, solid organ transplant, iatrogenic immunosuppression, chronic renal failure, nephrotic syndrome)
• Anatomic or functional asplenia (including sickle cell disease)
• CSF leak
• Cochlear implant

For these patients:

• Give 1 dose of PCV13 if not previously received 1
• Follow with PPSV23 at least 8 weeks after PCV13 1, 7, 5
• For immunocompromised patients, give a second dose of PPSV23 at least 5 years after the first PPSV23 7

Immunocompetent Adults 19-64 Years with Chronic Conditions

• PCV13 is not routinely recommended for adults with chronic heart disease, chronic lung disease, diabetes, chronic liver disease, alcoholism, or cigarette smoking 1
• These patients should receive PPSV23 only (one dose) 1
• Shared clinical decision-making may be considered if they reach age ≥65 years 1

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Critical Timing Intervals

Minimum Intervals Between Doses

• Between PCV13 doses in infants <12 months: 4 weeks minimum 2
• Between PCV13 doses in children ≥12 months: 8 weeks minimum 2, 3
• Between PCV13 and PPSV23 for immunocompromised patients: 8 weeks minimum 1, 7, 5
• Between PCV13 and PPSV23 for immunocompetent adults ≥65 years: 1 year minimum 1, 7

Special Timing Considerations

• Complete PCV13 vaccination at least 2 weeks before elective splenectomy, immunosuppressive therapy, or cochlear implant placement 3, 7
• If PPSV23 was given first, wait at least 1 year before giving PCV13 7, 8

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Important Clinical Caveats

Common Pitfalls to Avoid

• Do not co-administer PCV13 and PPSV23 on the same day—this reduces immunogenicity 7
• Do not give multiple PPSV23 boosters beyond recommended doses—no evidence supports safety or benefit of three or more doses 7
• Prior PPSV23 administration diminishes subsequent PCV13 response—always give PCV13 first when both are indicated 8
• Do not delay vaccination waiting for complete medical records—use verbal history and proceed with indicated vaccination 7

Administration Details

• Intramuscular injection only 4
• Shake pre-filled syringe vigorously until homogeneous white suspension before administration 4
• Each dose is 0.5 mL 4

Updated Context (2024)

• Newer vaccines (PCV20, PCV21, PCV15) are now preferred over PCV13 for adults as they provide broader serotype coverage 6, 7, 9
• The decline in PCV13-type disease due to pediatric vaccination programs has made routine adult PCV13 use less cost-effective 1
• PCV13 recommendations remain valid but are being superseded by higher-valency vaccines in clinical practice 6, 7, 9