Key points
- CDC recommends pneumococcal vaccination for children and adults at increased risk for pneumococcal disease.
- Follow the recommended immunization schedule to ensure that your patients get the pneumococcal vaccines that they need.
Children 2 through 5 years old
The following guidance applies to children in this age group who have a risk condition.
Unvaccinated or <3 PCV doses before age 2 years
Give 2 doses of PCV15 or PCV20. Give the second dose at least 8 weeks after the first.
Determine if they have ever received a dose of PCV20:
- Their pneumococcal vaccines are complete.
- See "Complete PCV series that didn't include PCV20" guidance below.
3 PCV doses before 12 months but no booster dose at or age 12 months
Give 1 dose of PCV15 or PCV20.
Determine if they have ever received a dose of PCV20:
- Their pneumococcal vaccines are complete.
- See "Complete PCV series that didn't include PCV20" guidance below.
Complete PCV series that included PCV20
Their pneumococcal vaccines are complete.
Complete PCV series that didn't include PCV20
Recommendations depend on if the child's risk condition is an immunocompromising condition.
Immunocompromising condition
Determine if they have ever received a dose of PPSV23:
- Then no pneumococcal vaccines are recommended at this time.
- Wait until at least 5 years have passed since they received their first PPSV23 dose.
- Then give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.
- Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
- When PCV20 is used, their vaccines are then complete.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their vaccines will then be complete.
Not an immunocompromising condition
Determine if they have ever received a dose of PPSV23:
- Their pneumococcal vaccines are complete.
- Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after last PCV dose. Regardless of vaccine used, their pneumococcal vaccines are then complete.
Children 6 through 18 years old
The following guidance applies to children in this age group who have a risk condition.
Never received PCV13, PCV15, or PCV20
Give 1 dose of PCV15 or PCV20 at least 8 weeks after the most recent pneumococcal vaccine dose. Give it regardless of whether the child has previously received PPSV23 or PCV7.
- It should be followed by a dose of PPSV23 if not previously given.
- It doesn't need to be followed by a dose of PPSV23.
Received PCV13 or PCV15 before age 6 years, never received PCV20
Recommendations depend on if the child's risk condition is an immunocompromising condition.
Immunocompromising condition
Determine if they already received PPSV23:
- Then no pneumococcal vaccines are recommended at this time.
- Wait until at least 5 years have passed since they received their first PPSV23 dose.
- Then give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their pneumococcal vaccines will then be complete.
- Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after the last PCV dose.
- When PCV20 is used, their pneumococcal vaccines are then complete.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give either 1 dose of PCV20 or a second dose of PPSV23. Regardless of vaccine used, their pneumococcal vaccines will then be complete.
Not an immunocompromising condition
Determine if they already received PPSV23:
- Their pneumococcal vaccines are complete.
- Give 1 dose of either PCV20 or PPSV23 at least 8 weeks after most recent pneumococcal vaccine dose. Regardless of vaccine used, their pneumococcal vaccines are then complete.
Adults 19 through 64 years old
Job Aid for Adult Recommendations
The following guidance applies to adults younger than 65 years who have a risk condition.
Never received any pneumococcal vaccineA
Give 1 dose of PCV15 or PCV20:
- It should be followed by a dose of PPSV23 at least 1 year later. The minimum interval (8 weeks) can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. Their pneumococcal vaccines will then be complete.
- It doesn't need to be followed by a dose of PPSV23. Their pneumococcal vaccines are complete.
Only received PPSV23
Give 1 dose of PCV15 or PCV20 at least 1 year after the most recent PPSV23 vaccination. Regardless of vaccine given, an additional dose of PPSV23 isn't recommended since they already received it. Their pneumococcal vaccines are complete.
Only received PCV13
Recommendations depend on the person's risk condition.
Immunocompromising condition
Give 1 dose of PCV20 or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 is used, their pneumococcal vaccines are then complete.
- It should be given at least 8 weeks after PCV13.
- When PPSV23 is used, they need another pneumococcal vaccine at least 5 years later. At that time, give either 1 dose of PCV20 or a second dose of PPSV23.
- When PCV20 is used, their vaccines will then be complete.
- When a second PPSV23 dose is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Cerebrospinal fluid leak or cochlear implant
Give 1 dose of PCV20 or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 is used, their pneumococcal vaccines are then complete.
- It should be given at least 8 weeks after PCV13.
- When PPSV23 is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Other risk condition*
Give 1 dose of PCV20 or PPSV23:
- It should be given at least 1 year after PCV13.
- When PCV20 is used, their pneumococcal vaccines are then complete.
- It should be given at least 1 year after PCV13.
- When PPSV23 is used, no additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
*e.g., alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes mellitus
Received PCV13 and 1 dose of PPSV23
Recommendations depend on the person's risk condition.
Immunocompromising condition
Give 1 dose of PCV20 or a second PPSV23 dose:
- It should be given at least 5 years after the last pneumococcal vaccine.
- Their pneumococcal vaccines are then complete.
- It should be given at least 8 weeks after PCV13 and 5 years after first PPSV23 dose. No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Cerebrospinal fluid leak or cochlear implant
Give 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine. Their vaccines are then complete.
Note: A second dose of PPSV23 isn't recommended at this age for these patients. If PCV20 isn't administered, then review pneumococcal vaccine recommendations again when the patient turns 65 years old.
Other risk condition*
No additional pneumococcal vaccines are recommended until at least age 65 years. Review pneumococcal vaccine recommendations again when the patient turns 65 years old.
*e.g., alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes mellitus
Risk conditions
Children and adults
Many conditions are an indication for pneumococcal vaccination for both children and adults:
- Cerebrospinal fluid leak
- Chronic liver disease
- Cochlear implant
- An immunocompromising condition
- Diabetes mellitus
The following are considered immunocompromising conditions in both children and adults:
- Congenital or acquired asplenia, or splenic dysfunction
- Congenital or acquired immunodeficiencyB
- Diseases or conditions treated with immunosuppressive drugs or radiation therapyC
- HIV infection
- Sickle cell disease or other hemoglobinopathy
Children specifically
The following risk conditions are only an indication for pneumococcal vaccination of children:
- Chronic heart disease
- Particularly cyanotic congenital heart disease and cardiac failure
- Particularly cyanotic congenital heart disease and cardiac failure
- Chronic kidney disease, excluding maintenance dialysis or nephrotic syndrome
- Chronic liver disease
- Chronic lung disease
- Includes moderate persistent or severe persistent asthma
- Includes moderate persistent or severe persistent asthma
- Maintenance dialysis or nephrotic syndrome
Adults specifically
The following risk conditions are only an indication for pneumococcal vaccination of adults:
- Alcoholism or cigarette smoking
- Chronic heart disease
- Includes congestive heart failure and cardiomyopathies
- Excludes hypertension
- Includes congestive heart failure and cardiomyopathies
- Chronic lung disease
- Includes chronic obstructive pulmonary disease, emphysema, and asthma
- Includes chronic obstructive pulmonary disease, emphysema, and asthma
- Chronic renal failure or nephrotic syndrome
Resources
Immunization schedules
Child and adolescent immunization schedule
Other resources
- Also applies to people who received PCV7 at any age and no other pneumococcal vaccines.
- Includes B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
- Includes Hodgkin disease, leukemia, lymphoma, malignant neoplasm, and solid organ transplant