Recommended Pneumococcal Conjugate Vaccine Schedule for Healthy Infants
All healthy infants in the United States should receive a 4-dose series of pneumococcal conjugate vaccine (either PCV15 or PCV20) at 2,4,6, and 12-15 months of age, with the first dose administered as early as 6 weeks of age. 1, 2, 3
Standard Vaccination Schedule
The routine immunization series consists of:
- Dose 1: 2 months of age (can start as early as 6 weeks) 1, 2, 3
- Dose 2: 4 months of age 1, 2, 3
- Dose 3: 6 months of age 1, 2, 3
- Dose 4 (booster): 12-15 months of age, administered at least 8 weeks after the third dose 1, 2, 3
Minimum Intervals Between Doses
- For infants <12 months: Minimum 4 weeks between doses (though 8 weeks is preferred) 1, 2
- For children ≥12 months: Minimum 8 weeks between doses 1, 2
- Between dose 3 and dose 4: At least 8 weeks, with dose 4 given at 12-15 months 1, 2, 3
Key Clinical Considerations
Vaccine Selection
Either PCV15 or PCV20 is acceptable for the routine infant series, though PCV20 provides broader serotype coverage against invasive pneumococcal disease and otitis media compared to PCV15. 3, 4 The FDA has licensed PCV20 for use starting at 6 weeks of age for prevention of invasive disease caused by 20 serotypes and otitis media caused by 7 serotypes. 3
Special Populations
Premature infants (<37 weeks gestation) who are medically stable should receive pneumococcal conjugate vaccine at the recommended chronologic age (not corrected age), concurrent with other routine vaccinations. 1, 2 However, apnea following intramuscular vaccination has been observed in some premature infants, so decisions should consider the individual infant's medical status. 3
Concurrent Administration
Pneumococcal conjugate vaccine should be administered concurrently with other routine childhood vaccines at separate injection sites. 1, 2 Do not mix PCV with other vaccines in the same syringe. 3
Catch-Up Schedules for Delayed Vaccination
If an infant misses scheduled doses, do not restart the series—simply continue where left off. 1, 2
For infants 7-11 months starting vaccination:
- 3 total doses: First 2 doses at least 4 weeks apart, third dose at 12-15 months (at least 8 weeks after second dose) 5, 3
For children 12-23 months starting vaccination:
For healthy children 24-59 months who never received PCV:
Protection and Duration
Healthy children who complete the 4-dose series maintain protection throughout childhood without requiring booster doses after age 5 years, with 97.4% efficacy against invasive pneumococcal disease caused by vaccine serotypes. 1 No additional pneumococcal vaccines are needed after completing this series unless high-risk conditions develop. 1
Safety Profile
The vaccine is safe with only minor adverse events:
- Local reactions (pain, redness, swelling at injection site): 10-40% of recipients 1, 3, 6
- Systemic reactions (irritability, drowsiness, decreased appetite): 54-68% 3, 6
- Fever ≥38°C: 15-25% within first 2 days post-vaccination 1, 2, 7
- Most reactions are mild to moderate in severity 6
Critical Pitfalls to Avoid
Do not use PPSV23 (23-valent polysaccharide vaccine) in children <2 years of age—it is not immunogenic in this age group and only indicated for high-risk children ≥2 years. 1, 2
Do not delay vaccination if doses are missed—interruption of the schedule does not require restarting the entire series or adding extra doses. 5, 1, 2
Do not give routine PCV to healthy children ≥5 years—it is not recommended for this age group unless high-risk conditions are present. 1
Do not forget that children with high-risk conditions (immunocompromising conditions, functional/anatomic asplenia, cochlear implants, CSF leaks) require additional doses beyond the routine 4-dose series and subsequent PPSV23 after age 2 years. 1