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Recommendations for immunization with PCV13/PCV15 and PPSV23 for children at high risk of pneumococcal disease who are 6 through 18 years of age

Recommendations for immunization with PCV13/PCV15 and PPSV23 for children at high risk of pneumococcal disease who are 6 through 18 years of age
High-risk condition Pneumococcal vaccine history* Pneumococcal vaccines needed for completion
Immune compromised:
  • Congenital or acquired asplenia or splenic dysfunction, including sickle cell disease or other hemoglobinopathies
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic kidney failure
  • Nephrotic syndrome
  • Generalized malignancy
  • Hematologic malignancy
  • Iatrogenic immunosuppression (eg, immunosuppressive drugs or radiation therapy, solid organ transplant)
  • No doses of PCV13/PCV15
  • No doses of PPSV23
  • 1 dose of PCV13/PCV15
  • First dose of PPSV23 ≥8 weeks after PCV13/PCV15
  • Second dose of PPSV23 ≥5 years after the first
  • No doses of PCV13/PCV15
  • 1 dose of PPSV23
  • 1 dose of PCV13/PCV15 ≥8 weeks after PPSV23
  • Second dose of PPSV23 ≥5 years after the first
  • No doses of PCV13/PCV15
  • 2 doses of PPSV23
  • 1 dose of PCV13/CPV15 ≥8 weeks after last dose of PPSV23
  • ≥1 dose of PCV13/PCV15
  • No doses of PPSV23
  • First dose of PPSV23 ≥8 weeks after PCV13/PCV15
  • Second dose of PPSV23 ≥5 years after the first
  • ≥1 dose of PCV13/PCV15
  • 1 dose of PPSV23
  • Second dose of PPSV23 ≥5 years after the first
  • ≥1 dose of PCV13/PCV15
  • 2 doses of PPSV23
  • No additional immunization necessary
Immune competent with CSF leak or cochlear implant
  • No doses of PCV13/PCV15
  • No doses of PPSV23
  • 1 dose of PCV13/PCV15
  • 1 dose of PPSV23 ≥8 weeks after PCV13/PCV15
  • 1 dose of PCV13/PCV15
  • No doses of PPSV23
  • 1 dose of PPSV23 ≥8 weeks after PCV13/PCV15
  • No doses of PCV13/PCV15
  • ≥1 dose of PPSV23
  • 1 dose of PCV13/PCV15 ≥8 weeks after the last PPSV23
Immune competent with chronic conditions including:
  • Chronic heart disease
  • Chronic lung disease
  • Diabetes mellitus
  • Chronic liver disease
  • Alcoholism
  • No doses of PCV13/PCV15
  • No doses of PPSV23
  • 1 dose of PPSV23
  • No dose of PCV13/PCV15
  • ≥1 dose of PPSV23
  • No additional immunization necessary
This table is intended for use in conjunction with the UpToDate topic on pneumococcal vaccination in children. PCV13 and PCV15 are interchangeable. When obtaining the pneumococcal vaccination history, doses that are unknown or uncertain should not be counted. Refer to UpToDate content on pneumococcal vaccination in children for additional details.

PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine; CSF: cerebrospinal fluid; PCV7: 7-valent pneumococcal conjugate vaccine.

* The number of doses of PCV13/PCV15 does not include doses of PCV7.

¶ High-risk children with immune-compromising conditions require a second dose of PPSV23, usually ≥5 years after the first. For patients with sickle cell disease, some experts recommend an interval of three years between the first and second dose of PPSV23[1], whereas others recommend an interval of five years[2-5]. A second dose of PPSV23 is not recommended for immunocompetent children with CSF leak, cochlear implant, or chronic conditions.
Based on recommendations from:
  1. National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease. Expert Panel Report, 2014. Available at: www.nhlbi.nih.gov/health-pro/guidelines/sickle-cell-disease-guidelines (Accessed on August 28, 2018).
  2. American Academy of Pediatrics. Streptococcus pneumoniae (pneumococcal) infections. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.717.
  3. Nuorti JP, Whitney CG, Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children–use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine–recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
  4. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2013; 62:521.
  5. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine among U.S. children: Updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1174.
  6. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58:e44.
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