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 any PCV, 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:
August 8, 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:
August 8, 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:
August 8, 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:
August 8, 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 PCV13 or PCV15 and PPSV23 is 1 year, and the minimum interval is 8 weeks.
Last reviewed:
August 8, 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:
August 8, 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:
August 8, 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 then nothing at all.
Last reviewed:
August 8, 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:
August 8, 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:
August 8, 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/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.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:
August 8, 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:
August 8, 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, including any dose administered on or after age 65, 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:
August 8, 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:
August 8, 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:
August 8, 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:
August 8, 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:
August 8, 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:
Immunize.org Resources:
Last reviewed:
August 8, 2024
