Which underlying medical conditions indicate that a child age 6 through 18 years should receive additional doses of pneumococcal vaccine beyond the routine schedule?

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.