Ask the Experts: Pneumococcal: Recommendations for Children

Results (15)

In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of Streptococcus pneumoniae and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten years later in February 2010, a new 13-valent product was licensed — PCV13 (Prevnar 13, Pfizer) — which added 6 new serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes accounted for the majority of invasive pneumococcal disease (IPD) in the U.S. at the time, including serotype 19A, which is the most common IPD-causing serotype in young children. In February 2010 ACIP recommended that healthcare providers transition from use of PCV7 to use of PCV13 for routine vaccination of children.

PCV7 was initially recommended for routine use in infants and children ages 2 through 59 months. The recommendations were expanded with the licensure of PCV13 to include vaccination of children age 60 through 71 months with underlying medical conditions, and also vaccination of older children, ages 6 through 18 years, with medical conditions placing them at increased risk of invasive pneumococcal disease.

PCVs were further updated with licensure for use in children of PCV15 in 2022 and PCV20 in 2023.

Last reviewed: November 13, 2024

All infants should be given a primary series of either PCV15 or PCV20, at ages 2, 4, and 6 months with a booster at age 12 to 15 months. Otherwise healthy children who fall behind should be given catch-up vaccination through age 59 months; if they have certain underlying medical conditions they should be given catch-up vaccination through age 71 months.

For pneumococcal vaccination of children ages 2 through 5 years, see the job aid linked to the CDC summary of recommendations here: www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html.

Immunize.org offers a print-ready clinical resource that addresses pneumococcal vaccination recommendations for all children, including those with any relevant health condition or incomplete vaccination history, entitled Recommendations for Pneumococcal Vaccines Use in Children and Teens: www.immunize.org/wp-content/uploads/catg.d/p2016.pdf.

Last reviewed: November 13, 2024

The conditions that increase the risk of pneumococcal disease and are indications for additional pneumococcal vaccine doses beyond the routine schedule are broken down into two categories: non-immunocompromising (non-IC) and immunocompromising (IC). Recommendations differ slightly under certain circumstances by IC or non-IC category.

Non-IC conditions include:

  • Cerebrospinal fluid (CSF) leak
  • Chronic heart disease (especially cyanotic congenital heart disease and heart failure)
  • Chronic kidney disease (except as specified in the IC list below)
  • Chronic liver disease
  • Chronic lung disease (including moderate persistent or severe persistent asthma)
  • Diabetes mellitus
  • Cochlear implant

Immunocompromising (IC) conditions include:

  • 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

An older child through age 18 years with any high-risk condition who completed a pneumococcal conjugate series before age 6 years that included any dose of PCV20, is not recommended to receive any additional PCV doses.

Children with IC or non-IC conditions who completed a PCV series before age 6 years with PCV13 or PCV15 (but who have not received PCV20 or pneumococcal polysaccharide vaccine [PPSV23]) should receive additional pneumococcal vaccination with a single dose of PCV20 at least 8 weeks after the most recent PCV dose. If PCV20 is not available, a non-IC or IC child in this circumstance may, alternatively, receive a single dose of PPSV23 at least 8 weeks after the most recent PCV dose. An IC child given PPSV23 in this circumstance would also be due for a dose of either PCV20 or a second dose of PPSV23 at least 5 years after the first PPSV23.

Doses of the 7-valent PCV (the original Prevnar, PCV7) do not count toward PCV vaccination when determining the current pneumococcal vaccination needs of a child or teen with a qualifying non-IC or IC condition.

When feasible, administer any needed pneumococcal vaccination at least two weeks before initiating planned interventions that place a child at high risk (such as a cochlear implant or spleen removal).

Immunize.org details all recommendations and options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens (www.immunize.org/wp-content/uploads/catg.d/p3086.pdf) and its shorter resource, Recommendations for Pneumococcal Vaccines use in Children and Teens (www.immunize.org/wp-content/uploads/catg.d/p2016.pdf).

For a complete explanation of pneumococcal vaccination recommendations for ages 6 through 18 years, CDC has summarized the recommendations here: www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html#children-6-18.

Last reviewed: November 13, 2024

Regardless of risk, all children should receive routine vaccination with either PCV15 or PCV20 as age-appropriate. A child age 2 through 18 years with any of the conditions listed below may require additional pneumococcal vaccination depending on their age and prior vaccination status.

The conditions that increase the risk of pneumococcal disease and are indications for additional pneumococcal vaccine doses beyond the routine schedule are broken down into two categories: non-immunocompromising (non-IC) and immunocompromising (IC). Recommendations differ slightly under certain circumstances by IC or non-IC category.

Non-IC conditions include:

  • Cerebrospinal fluid (CSF) leak
  • Chronic heart disease (especially cyanotic congenital heart disease and heart failure)
  • Chronic kidney disease (except as specified in the IC list below)
  • Chronic liver disease
  • Chronic lung disease (including moderate persistent or severe persistent asthma)
  • Diabetes mellitus
  • Cochlear implant

Immunocompromising (IC) conditions include:

  • 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

For timing of vaccination following hematopoietic stem cell transplant, see see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html

CDC guidance is available at www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html.

Immunize.org details all recommendations and options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens (www.immunize.org/wp-content/uploads/catg.d/p3086.pdf) and its shorter resource, Recommendations for Pneumococcal Vaccines use in Children and Teens (www.immunize.org/wp-content/uploads/catg.d/p2016.pdf).

Last reviewed: November 13, 2024

Because of the limited number of serogroups covered by PCV7 (which was used in the United States between 2000 and 2010), CDC recommends that doses of PCV7 should be ignored for the purposes of calculating the current pneumococcal vaccination needs of an older teen or adult patient at increased risk for pneumococcal disease. For example, a person at high risk of pneumococcal disease who received a complete series of PCV7 vaccination in early childhood should follow the vaccination recommendations for someone with their condition who has not received any doses of pneumococcal conjugate vaccine.

Last reviewed: November 13, 2024

Both PCV15 and PCV20 are recommended as pneumococcal vaccination options for children age 6 weeks and older as well as for older children age 6 through 18 years with certain medical conditions or other risk factors for pneumococcal disease. ACIP no longer recommends PCV13 for children or adults; however, PCV13 may be given as previously recommended if it is the only PCV available and the recipient would otherwise go without vaccination. Pneumococcal polysaccharide vaccine (PPSV23) is recommended as an option for some children age 2 years and older who have certain underlying medical conditions and who have not had (or do not have the option of receiving) PCV20.

Details of the recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7239a5-H.pdf (for PCV20) and www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7137a3-H.pdf (for PCV15). These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html.

A summary of these recommendations can also be found at www.immunize.org/wp-content/uploads/catg.d/p2016.pdf. Immunize.org has developed standing orders for pneumococcal vaccination of children and teens at www.immunize.org/wp-content/uploads/catg.d/p3086.pdf.

Last reviewed: November 13, 2024

PPSV23 has only limited indications in children age 2 through 18 years who have not had PCV20 and are at high risk for serious pneumococcal infection due to the presence of a specific non-immunocompromising (non-IC) or immunocompromising (IC) medical condition.

If PCV20 is not offered, PPSV23 is recommended as an option to be administered to a child age 2 years or older at least 8 weeks following completion of PCV vaccination with PCV13 or PCV15. If a child has an immunocompromising condition and PPSV23 is used, a dose of PCV20, or a second dose of PPSV23, should be given 5 years later.

Immunize.org details all recommendations and pneumococcal vaccine options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens (www.immunize.org/wp-content/uploads/catg.d/p3086.pdf) and its shorter resource, Recommendations for Pneumococcal Vaccines Use in Children and Teens (www.immunize.org/wp-content/uploads/catg.d/p2016.pdf).

Last reviewed: November 13, 2024

ACIP does not recommend routine PCV vaccination of healthy children 60 months of age or older. If there is a school requirement, the simplest solution is to give the child one dose of either PCV15 or PCV20 now. However, health insurance may not pay for this dose. For more information on the ACIP recommendations for pneumococcal vaccination of children, go to CDC’s summary of pneumococcal vaccine recommendations: www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html.

Last reviewed: November 13, 2024

No. No data exist at this time to indicate that people younger than 19 who smoke are at increased risk of pneumococcal disease.

Last reviewed: November 13, 2024

PPSV23 is not effective in children less than 24 months of age. PPSV23 given to children younger than 2 years old should not be considered part of the pneumococcal vaccination series. PCV15 or PCV20 should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified. The facility staff should review their vaccination training and clinical procedures to prevent future vaccine administration errors.

Last reviewed: November 13, 2024

Selective IgA deficiency is a B-cell immunodeficiency, so additional pneumococcal vaccination beyond the routine age-based schedule is indicated for this 6-year-old with an immunocompromising condition. Because the child received a complete PCV13 series, the current recommendation is to administer a single dose of PCV20 or PPSV23 at least 8 weeks following the most recent PCV dose. If PCV20 is given, no further doses of pneumococcal vaccine are recommended. If PPSV23 is given now, then at least 5 years later give a dose of PCV20 or a second dose of PPSV23. See CDC’s recommendations at: www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/risk-indications.html. 

Last reviewed: November 13, 2024

No. No additional doses of pneumococcal vaccine are recommended.

Last reviewed: November 13, 2024

Do not restart the series or give additional doses. The previously administered doses of PCV13 are valid. Complete the pneumococcal conjugate vaccination series with either PCV15 or PCV20 in accordance with the routine schedule.

Last reviewed: November 13, 2024

A CDC study showed a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. The risk for febrile seizures in children who received PCV15 or PCV20 concurrently with an influenza vaccine has not been studied.

See www.cdc.gov/vaccine-safety/about/febrile-seizures.html for more information about febrile seizures after vaccination.

Last reviewed: November 13, 2024

Yes. Pneumococcal vaccination is recommended for adults age 19 through 49 years with all types of asthma.

Among children age 2 through 18 years, only those with moderate persistent or severe persistent asthma (regardless of high-dose oral corticosteroids use) should be evaluated for additional pneumococcal vaccine doses beyond the routine age-based schedule. Specific recommendations depend on age and the recipient’s specific pneumococcal vaccination history, including prior doses of any pneumococcal vaccine except PCV7. Prior doses of PCV7 may be ignored for the purposes of determining doses due now.

Last reviewed: November 13, 2024

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