Pneumococcal Vaccine

There are 2 types of pneumococcal vaccines: conjugate and polysaccharide.

The 13-valent pneumococcal conjugate vaccine (PCV13) contains 13 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 9V, 14, 18C, 19A, 19F, 23F).

The 15-valent pneumococcal conjugate vaccine (PCV15) contains 15 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F).

The 20-valent pneumococcal conjugate vaccine (PCV20) contains 20 purified capsular polysaccharides of S. pneumoniae (1, 3, 4, 5, 6A, 6 B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F).

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) contains antigens from the 23 most virulent of the 83 subtypes of S. pneumoniae (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F).

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 older people. It reduces pneumonia incidence.

Children up to 18 years of ageCDC: Pneumococcal Vaccination: Summary of Who and When to Vaccinate and CDC: Child and Adolescent Immunization Schedule by Age).

Adults age 65 years or older who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown should receive either

• 1 dose of PCV20 or

• 1 dose of PCV15 followed by a dose of PPSV23

Adults 19 to 64 years who have certain medical conditions or other risk factors and who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown should receive either

• 1 dose of PCV20 OR

• 1 dose of PCV15 followed by a dose of PPSV23

The applicable medical conditions and risk factors include the following:

• Alcohol use disorder

• Chronic heart, lung, or liver disease

• Chronic renal failure or nephrotic syndrome

• Cigarette smoking

• Cochlear implant

• Congenital or acquired asplenia

• Cerebrospinal fluid leak

• Diabetes mellitus

• Generalized cancer

• HIV

• Hodgkin disease

• Immunodeficiency or immunosuppression

• Leukemia, lymphoma, or multiple myeloma

• Solid organ transplants

• Sickle cell disease or other hemoglobinopathies

For both adult age groups,CDC: Pneumococcal Vaccination: Summary of Who and When to Vaccinate and CDC: Adult Immunization Schedule by Age.

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 PCV15 is

• A severe allergic reaction (eg, anaphylaxis) to any component of PCV15 or to diphtheria toxoid

The main contraindication for PCV20 is

• A severe allergic reaction (eg, anaphylaxis) to any component of PCV20 or to 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 with either type of vaccine include

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

For children with functional or anatomic asplenia, meningococcal conjugate vaccine (MenACWY) and PCV13 should not be given during the same visit but should be separated by ≥ 4 weeks.

The usual dose of each vaccine is

• 0.5 mL IM for PCV20

• 0.5 mL IM for PCV13

• 0.5 mL IM for PCV15

• 0.5 mL IM or subcutaneous for PCSV23

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

Adults aged 19 to 64 years 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 second dose of PPSV23 5 years 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 years have elapsed since their previous PPSV23 dose, they should be given another dose of the vaccine at age 65 or later. The second dose is given 5 years 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.

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

For dosing schedules in children, see CDC: Pneumococcal Vaccination: Summary of Who and When to Vaccinate and CDC: Child and Adolescent Immunization Schedule by Age.

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

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): Pneumococcal ACIP Vaccine Recommendations

2. ACIP: Recommended Adult Immunization Schedule, United States, 2023 including Changes to the 2023 Adult Immunization Schedule

3. Centers for Disease Control and Prevention (CDC): Pneumococcal Vaccination: Information for Healthcare Professionals

4. European Centre for Disease Prevention and Control (ECDC): Pneumococcal Disease: Recommended vaccinations 2023