Recommendations for adult dialysis patients vary by age and pneumococcal conjugate (PCV) or polysaccharide (PPSV23) vaccination history:
- Adult dialysis patients who have not previously received pneumococcal vaccination should receive either PCV20 or PCV21 alone or a series of PCV15 followed by PPSV23 at least 8 weeks later. No further pneumococcal vaccines are recommended.
- Adult dialysis patients who are age 19 through 49 and have already received one dose of PPSV23 may receive one dose of any currently recommended PCV (PCV15, PCV20, or PCV21) one year after the dose of PPSV23; no further doses of PPSV23 are recommended.
- Adult dialysis patients who are 50 or older and who have received PCV13 and PPSV23 in the past should receive one dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccination.
- Adult dialysis patients who received PCV13 at any point and also received a PPSV23 vaccination after turning 65 are not routinely recommended to receive any additional doses of pneumococcal vaccine. They have the option to receive a dose of PCV20 or PCV21 at least 5 years after their most recent pneumococcal vaccination on the basis of shared clinical decision-making, based upon their risk of pneumococcal disease and desire for additional protection.
Last reviewed:
November 13, 2024
CDC’s guidance is to ignore the remote history of PCV7 and evaluate the patient as if he has never had pneumococcal vaccination. The patient should receive PCV20 or PCV21 alone or PCV15 in series with PPSV23 given at least one year later. If using PCV15, and if the high-risk condition is immunocompromising or if the patient has a cochlear implant or cerebrospinal fluid leak, you may consider administering the PPSV23 as soon as 8 weeks after PCV15.
Last reviewed:
November 13, 2024
No. As of October 2024, CDC recommends that adults with immunocompromising conditions who received a dose of PPSV23 in the past and were previously recommended to receive a second PPSV23 dose at least 5 years after that initial PPSV23 dose should now complete their pneumococcal immunization schedule with PCV20 or PCV21 at least 5 years after the PPSV23 dose.
Last reviewed:
November 13, 2024
In October 2024, CDC updated its guidance to state that an adult who received PCV13 should receive PCV20 or PCV21at least 1 year later. PPSV23 is no longer recommended as an option following PCV13.
Last reviewed:
November 13, 2024
ACIP and CDC do not recommend revaccination with a second dose of PPSV23 for adults 19 through 49 with asplenia who receive PCV15 (Vaxneuvance, Merck) followed by PPSV23.
If the adult patient with asplenia had received PCV13 (Prevnar 13, Pfizer) followed by PPSV23 (instead of Vaxneuvance), then CDC recommends administration of a dose of PCV20 or PCV21 at least 5 years after the dose of PPSV23.
Last reviewed:
November 13, 2024
Based on changes to the ACIP recommendations made in October 2024, a second dose of PPSV23 is no longer recommended for any adult. Adults age 19 through 49 years with immunocompromising conditions who received a dose of PCV15 followed by a dose of PPSV23 have received a complete pneumococcal vaccine schedule, and no further doses are recommended. If they received PCV13 and PPSV23, instead of PCV15, CDC recommends a dose of PCV20 or PCV21 should be given 5 years after the first dose of PPSV23, if the patient has have one of the following immunocompromising conditions:
- Kidney disease and on maintenance dialysis
- Kidney disease with nephrotic syndrome
- Asplenia or splenic dysfunction
- Congenital or acquired immunodeficiency, including B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
- Treatment with immunosuppressive drugs or radiation therapy (including treatment for Hodgkin disease, leukemias, lymphomas, malignant neoplasm, and solid organ transplant)
- HIV infection
- Sickle cell disease or other hemoglobinopathies
Last reviewed:
November 13, 2024
They need a dose of PCV20 or PCV21, but not another dose of PPSV23. CDC recommends that people age 50 or older who received PCV13 and either one or two doses of PPSV23 before age 65 should receive a dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccine dose. If they received PCV15 followed by PPSV23, they are not recommended to receive any additional pneumococcal vaccine doses at this time.
A patient age 50 or older who received one or two doses of PPSV23 earlier in life but has not received any PCV product, or their history of PCV vaccination is only PCV7 or unknown, is recommended to receive a single dose of a currently recommended pneumococcal conjugate vaccine (PCV15, PCV20, or PCV21) at least one year after the last dose of PPSV23.
Last reviewed:
November 13, 2024
No. This patient should receive a dose of PCV15, PCV20, or PCV21 now. As of October 2024, CDC does not recommend revaccination with PPSV23 for any adult who has received a dose of PPSV23.
Last reviewed:
November 13, 2024
Yes. There are more than 100 known serotypes of pneumococcus. Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, they should receive it even after one or more episodes of pneumococcal disease.
Last reviewed:
November 13, 2024
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than nasopharyngeal colonization with the organism.
Last reviewed:
November 13, 2024
PCV vaccines are conjugated to a type of diphtheria toxoid. If someone has a history of anaphylaxis following diphtheria-containing vaccine, it might be due to the diphtheria toxoid, and the cause of the anaphylactic allergy should be identified before the administration of a PCV vaccine. This could be difficult since no single-antigen diphtheria toxoid is available in the U.S. Fortunately, true anaphylactic allergy to diphtheria-containing vaccine is rare.
Last reviewed:
November 13, 2024
If you stock PCV15 and plan to use the PCV15 and PPSV23 combined series to vaccinate patients for whom this is an option, you should always give the PCV15 first. PCV is always recommended to be given before PPSV23, based on studies demonstrating a better immune response to serotypes contained in both vaccines when the conjugate vaccine is given first. These vaccines should not be given at the same visit.
The routine interval between PCV15 and PPSV23 is one year; however, PPSV23 may be administered a minimum of 8 weeks after PCV15 when the recipient has an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. If PPSV23 is inadvertently administered first, wait a minimum of one year to administer PCV15, PCV20, or PCV21, because there is evidence that the immune response to serotypes contained in the PCV is diminished when PCV is administered soon after PPSV23.
Last reviewed:
November 13, 2024
PCV15 and PPSV23 vaccines should not be given at the same visit. When administering PCV15 followed by PPSV23, give PCV15 first followed by PPSV23 one year later. Providers can consider waiting a minimum interval of 8 weeks to give PPSV23 to people with immunocompromising conditions, cochlear implant, or cerebrospinal fluid (CSF) leak.
If a patient inadvertently received PPSV23 before PCV15, a minimum interval of at least 1 year between doses is recommended and a shorter interval is not recommended.
Last reviewed:
November 13, 2024
Give PCV15 first, at least 8 weeks after the most recent dose of PCV, followed by PPSV23 at least 8 weeks later. PCV15 and PPSV23 should not be given at the same visit. If a child has already received PPSV23, wait at least 8 weeks before giving PCV15 or PCV20 to the child.
Last reviewed:
November 13, 2024
PCV vaccines and PPSV23 should not be administered at the same visit or at an interval less than 8 weeks.
In children through age 18 years, if PCV and PPSV23 are administered at the same visit, the PCV dose should be repeated, and should be administered no earlier than 8 weeks after doses that were administered on the same day. However, in adults age 19 years or older, if a PCV and PPSV23 are administered at the same visit or at an interval less than 8 weeks, CDC recommends that neither dose be repeated.
Last reviewed:
November 13, 2024
Even though the interval was shorter than the recommended one year, the dose of PPSV23 should be counted and does not need to be repeated. ACIP recommends that the routinely recommended interval between PCV15 and PPSV23 is 1 year, and the minimum interval is 8 weeks.
Last reviewed:
November 13, 2024
What to do when doses of PCV15 and PPSV23 are given earlier than the recommended minimum interval of 8 weeks is not described in the ACIP pneumococcal recommendations. The CDC subject matter experts have provided the following guidance: in such a case, the dose given second does NOT need to be repeated. This is an exception to the usual procedure for a minimum interval violation (as described in CDC’s “General Best Practices Guidelines for Immunization”. The recommended interval between the dose of PCV15 and PPSV23 is one year and the recommended minimum interval between doses is 8 weeks.
Last reviewed:
November 13, 2024
When PCV15 is given to a healthy adult 65 years or older, PCV15 should be given first followed by PPSV23 one year later.
What to do when doses of PPSV23 and PCV15 are given before the recommended interval is not addressed in the ACIP recommendations. The CDC subject matter experts have advised that in such a case, the dose given second does NOT need to be repeated. This is an exception to the usual procedure for a minimum interval violation as described in CDC’s “General Best Practices Guidelines for Immunization” (see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html).
Last reviewed:
November 13, 2024
In this case, it is preferable to refer to a vaccination provider who can administer either PCV20 or PCV21 alone or PCV15 with plans to receive PPSV23 one year later. ACIP recommends that PCV15 be administered before PPSV23 for optimal immune response to vaccination. If there is a challenge in finding another location where the patient can receive a recommended PCV option, it is better to give PPSV23 than nothing at all.
Last reviewed:
November 13, 2024
Yes. If patients have an uncertain vaccination history and their records are not readily obtainable, you should administer the recommended doses: PCV20 or PCV21 alone or PCV15 followed by PPSV23 one year later. Extra doses will not cause harm to the patient. Per the CDC’s “General Best Practices for Immunization Guidelines”, self-reported doses of influenza and PPSV23 are acceptable. Therefore, if a patient remembers receiving PPSV23, it is acceptable to provide only one dose of PCV20, PCV21, or PCV15.
Last reviewed:
November 13, 2024
No. However, this person should receive PCV15, PCV20, or PCV21 one year after PPSV23 if he has no history or an unknown history of receiving a pneumococcal conjugate vaccine in the past.
Last reviewed:
November 13, 2024
It is preferable that the person planning to have the procedure be protected from pneumococcus at the time of the surgery; if possible, administer the appropriate vaccine at least two weeks in advance of the splenectomy or cochlear implant. If the procedure is done on an emergency basis, vaccinate as soon as possible after surgery. Adults who have not previously received any pneumococcal vaccine should receive either PCV20 or PCV21 alone or PCV15 followed by PPSV23 at least 8 weeks later.
Recommendations for vaccination of a child in this situation depends on the child’s age and pneumococcal vaccination history (number of doses and types of vaccine(s) received). To evaluate the specific needs of the child, see CDC’s guidance at www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/risk-indications.html or Immunize.org’s Recommendations for Pneumococcal Vaccination of Children and Teens at www.immunize.org/wp-content/uploads/catg.d/p2016.pdf.
Last reviewed:
November 13, 2024
All children with risk factors for pneumococcal disease or its complications should be vaccinated on time with either PCV15 or PCV20. High-risk children who complete the pneumococcal vaccination schedule without a dose of PCV20 will require additional pneumococcal vaccination. The vaccination needed after completion of the routine series (with PCV13, PCV15, or PCV20) depends on the pneumococcal vaccine product available, the child’s age, specific type of risk factor, and past pneumococcal vaccination history.
There are four resources that can help you determine what pneumococcal vaccinations are recommended for a specific high-risk child:
- From CDC:
- From Immunize.org:
Last reviewed:
November 13, 2024
No. PPSV23 was never recommended to be given every 5 years. If you see a patient age 65 years or older who, as a result of this practice of repeating doses of PPSV23, has had multiple doses of PPSV23, evaluate their history of pneumococcal conjugate vaccination. If they have no or unknown history of any doses of PCV, administer a single dose of PCV15, PCV20, or PCV21 at least 1 year after their most recent dose of PPSV23.
If they have also received a dose of PCV13 in the past, they may receive a dose of PCV20 or PCV21 at least 5 years after their most recent pneumococcal vaccination based on shared clinical decision-making.
Last reviewed:
November 13, 2024
Yes. The two available quadrivalent meningococcal conjugate vaccines, Menveo (MenACWY-CRM, GSK) and MenQuadfi (MenACWY-TT, Sanofi), may be administered at the same time as PCV13 or at any interval before or after receipt of PCV13.
Last reviewed:
November 13, 2024
No, but the PPSV23 will render the PCV15 dose less immunogenic. In this scenario, the best schedule is to give a MenACWY vaccination (any brand) simultaneously with either PCV15 or PCV20. If PCV20 is given, no additional pneumococcal vaccine doses are recommended. If PCV15 is given, then PPSV23 should be given at least eight weeks later. ACIP recommends giving PCV before PPSV23 in order to maximize the immune response to PCV. PPSV23 may blunt the immune response to the serotypes contained in PCV if PCV is given after PPSV23, although in children there is a smaller effect than in adults. PCV21 (Capvaxive, Merck) is not an option because it is not licensed or recommended for use in children. Note that a 10-year-old child with persistent complement component deficiency should also be vaccinated against meningococcal B disease.
Last reviewed:
November 13, 2024
Yes. Pneumococcal vaccines are all inactivated vaccines, which means you can give all other recommended vaccines at the same visit (using separate syringes) or at any later time with no waiting period following the vaccination. All currently available meningococcal vaccines in the United States may be administered without regard to the timing of pneumococcal vaccination.
Last reviewed:
November 13, 2024
No. The available data have been interpreted that any changes in antibody response to either vaccine’s components were clinically insignificant. If PCV20 and influenza vaccine are both indicated and recommended, they may be administered at the same visit.
Last reviewed:
November 13, 2024
No. There are no data on the effectiveness of pneumococcal conjugate vaccine given by the intravenous route. The patient has renal disease, so it is important to ensure that the dose they receive is effective. CDC recommends repeating the dose using the correct route of administration (intramuscular).
Last reviewed:
November 13, 2024
Pneumococcal vaccination recommendations are complex, especially as newer conjugate vaccines are licensed and added to recommended options. Assessing what is needed for an individual patient of any age requires their age, pneumococcal vaccination history, and knowledge of any relevant high-risk conditions. There are several resources available from CDC and Immunize.org that can help:
CDC Resources:
- PneumoRecs VaxAdvisor Mobile App for Vaccine Providers (webpage): The app for your mobile device allows you to answer basic questions about the age, health conditions, and pneumococcal vaccination history for an individual patient. It then provides CDC’s recommended options for pneumococcal vaccination today. See more information and download the app at www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/app.html.
Immunize.org Resources:
Last reviewed:
November 13, 2024
PPSV23 may be administered by intramuscular (IM) or subcutaneous (Subcut) routes. Pneumococcal conjugate vaccines are administered IM. Immunize.org has produced a simple handout that summarizes the dose, route, site, and needle length for administration of all recommended vaccines to adults and children: www.immunize.org/catg.d/p3085.pdf.
Last reviewed:
November 13, 2024
All pneumococcal vaccines should be refrigerated at temperatures between 2°C (36°F) and 8°C (46°F). Do not freeze these vaccines. Vaccine exposed to freezing temperature should not be administered. For details of vaccine storage and handling, see the CDC Vaccine Storage and Handling Toolkit: www.cdc.gov/vaccines/hcp/downloads/storage-handling-toolkit.pdf.
Last reviewed:
November 13, 2024
