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Pneumococcal Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine; Director, Internal Medicine Residency Program, Jefferson Medical College; Lankenau Medical Center ; Jerome Santoro, MD, Clinical Professor of Medicine; Chief, Department of Medicine, Jefferson Medical College; Lankenau Medical Center

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Patient Education

For more information, see Pneumococcal ACIP Vaccine Recommendations.

Certain medical conditions (eg, chronic disorders, immunocompromising conditions, CSF leaks, cochlear implants) increase the risk of pneumococcal disease.


The 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar®) contains 13 purified capsular polysaccharides of Streptococcus pneumoniae; each is coupled to a nontoxic variant of diphtheria toxin. This vaccine has replaced the 7-valent vaccine (PCV7); PCV13 contains the 7 serotypes in PCV7 plus 6 additional serotypes. The 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®) contains antigens from the 23 most virulent of the 83 subtypes of S. pneumococcus. Unlike the older PPSV23, PCV13 can stimulate antibody responses in infants. It also seems to confer greater protection against invasive pneumococcal disorders than PPSV23. PPSV23 reduces bacteremia by 56 to 81% in adults overall but is less effective in debilitated elderly people. It reduces pneumonia incidence.



PCV13 is recommended for

PCV13 is also recommended for people aged 6 to 64 yr with any of the following high-risk conditions:

  • A cochlear implant

  • CSF leak

  • Sickle cell disease or other hemoglobinopathy

  • Congenital or acquired asplenia

  • Immunocompromising conditions (eg, congenital immunodeficiency, chronic renal failure, nephrotic syndrome, HIV infection, leukemia, lymphomas, generalized cancer, use of immunosuppressants, solid organ transplant)


PPSV23 is recommended for

  • All adults ≥ 65 yr

PPSV23 is also recommended for people aged 6 to 64 yr with the high-risk conditions listed above. Additional criteria for adults aged 19 to 64 yr include the following:

  • A chronic lung disorder (including asthma)

  • Chronic cardiovascular disorders (excluding hypertension)

  • Diabetes mellitus

  • A chronic liver disorder

  • Chronic alcoholism

  • Cigarette smoking

PPSV23 is no longer recommended for routine use in American Indians and Alaska natives < 65 yr unless they have a medical condition or other indication for PPSV23. However, American Indians and Alaskan natives aged 50 to 64 yr may be given PPSV23 if they live in areas where risk of invasive pneumococcal disease is increased.

Contraindications and Precautions

The main contraindication for PCV13 is

  • A severe allergic reaction (eg, anaphylaxis) after a previous dose of PCV7 or PCV13, to a vaccine component, or to any vaccine containing diphtheria toxoid

The main contraindication for PPSV23 is

  • A severe allergic reaction after a previous dose of the vaccine or to a vaccine component

Precautions include

  • Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)


The usual dose is 0.5 mL IM for PCV13 and 0.5 mL IM or sc for PCSV23.

PCV13 is recommended as a 4-dose IM series for infants at age 2, 4, 6, and 12 to 15 mo. Children aged 7 to 59 mo who have not been vaccinated with PCV7 or PCV13 previously should be given 1 to 3 doses of PCV13, depending on their age at the initiation of the vaccination series and the presence of medical conditions. Children aged 24 to 71 mo with chronic medical conditions that increase their risk of pneumococcal disease should be given 2 doses of PCV13 at least 8 wk apart if unvaccinated. Interruption of the vaccination schedule does not require starting the entire series over or giving extra doses.

Children at high risk of pneumococcal disease (eg, children with sickle cell disease, asplenia, or a chronic disorder) should be given a dose of PPSV23 at age 24 mo at least 8 wk after the most recent dose of PCV13.

Children aged 14 to 59 mo who have received a complete age-appropriate series of PCV7 should be given a single supplemental dose of PCV13.

If children aged 6 to 18 yr with an immunocompromising condition, a cochlear implant, or a CSF leak have not been vaccinated with PCV13 or PPSV23, they should be given 1 dose of PCV13, followed by 1 dose of PPSV23 ≥ 8 wk later. If they have been vaccinated with PPSV23 but not PCV13, they are given 1 dose of PCV13 ≥ 8 wk after the last dose of PPSV23. Children with an immunocompromising condition should be revaccinated once with PPSV23 5 yr after the first dose. They should not be given > 2 doses of PPSV23.

If people need both vaccines, PCV13 should be given first, followed by PPSV23 at least 8 wk later. If people have already been vaccinated with PPSV23, administer PCV13 at least 8 wk after the most recent dose of PPSV23.

Adults aged ≥ 19 yr with immunocompromising conditions (eg, functional or anatomic asplenia, HIV infection), CSF leaks, or cochlear implants should be vaccinated with PCV13 and PSV23. If they have not previously been given PCV13 or PPSV23, they should be vaccinated with a dose of PCV13, followed by a dose of PPSV23 ≥ 8 wk later. If they have been given PPSV23 but not PCV13, they are given a dose of PCV13 ≥ 1 yr after the last dose of PPSV23.

People with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis.

Adults aged 19 to 64 yr at highest risk of pneumococcal disease (eg, with functional or anatomic asplenia, chronic kidney disease, or another immunocompromising condition, including cancer and use of corticosteroids) should be given a 2nd dose of PPSV23 5 yr after the first PPSV23 dose.

All people should be vaccinated with PPSV23 at age 65. If people were given 1 or 2 doses of PPSV23 before age 65 for any indication and ≥ 5 yr have elapsed since their previous PPSV23 dose, they should be given another dose of the vaccine at age 65 or later. The 2nd dose is given 5 yr after the first (eg, at age 69 if the previous dose was given at age 64). Those who are given PPSV23 at or after age 65 should be given only 1 dose.

If elective splenectomy is planned, PCV13 should be given ≥ 12 wk before surgery, followed by a dose of PPSV23 ≥ 8 wk after PCV13 is given. PPSV23 should be given at least 2 wk before elective splenectomy. If splenectomy must be done immediately, PCV13 should be given, followed by PPSV23 ≥ 8 wk later. If patients have already received PCV13, PPSV23 should not be given until ≥ 2 wk after splenectomy.

When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be ≥ 2 wk. People should be not be vaccinated during chemotherapy or radiation therapy.

Adverse Effects

Adverse effects are usually mild and include fever, irritability, drowsiness, anorexia, vomiting, and local pain and erythema.