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Recommendations for immunization with PCV13/PCV15 and PPSV23 for children at high risk* of pneumococcal disease who are 2 through 5 years of age

Recommendations for immunization with PCV13/PCV15 and PPSV23 for children at high risk* of pneumococcal disease who are 2 through 5 years of age
Pneumococcal vaccine history before age 2 years Pneumococcal vaccines needed for completion through age 5 years
No doses of PPSV23 and:
  • 4 doses of PCV13/PCV15
  • 1 dose of PPSV23 ≥8 weeks after last dose of PCV13/PCV15
  • 3 doses of PCV13/PCV15
  • 1 dose of PCV13/PCV15 ≥8 weeks after last dose of PCV13/PCV15
  • 1 dose of PPSV23 ≥8 weeks later
  • <3 doses of PCV13/PCV15
  • 2 doses of PCV13/PCV15 ≥8 weeks apart, beginning ≥8 weeks after last dose of PCV13/PV15
  • 1 dose of PPSV23 ≥8 weeks later
One dose of PPSV23 after age 2 years and:
  • 4 doses of PCV13/PCV15
  • Pneumococcal immunization through age 5 is complete
  • 3 doses of PCV13/PCV15
  • 1 dose of PCV13/PCV15 ≥8 weeks after last pneumococcal vaccine (PCV13/PSV15 or PPSV23)
  • <3 doses of PCV13/PCV15
  • 2 doses of PCV13/PCV15 ≥8 weeks apart, beginning ≥8 weeks after last pneumococcal vaccine (PCV13/PCV15 or PPSV23)
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 details.

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

* High-risk conditions include:
  • Immune-compromising conditions (eg, functional or anatomic asplenia [including sickle cell disease, other hemoglobinopathies, and congenital or acquired asplenia or splenic dysfunction], congenital or acquired immunodeficiency, HIV infection, chronic kidney failure, nephrotic syndrome, generalized malignancy, hematologic malignancy [eg, leukemia, lymphoma], iatrogenic immunosuppression)
  • CSF leak or cochlear implant in immune-competent children
  • Certain chronic conditions in immune-competent children (eg, chronic heart disease, chronic lung disease, diabetes mellitus, chronic liver disease, alcoholism)

¶ 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 anatomic barrier defects 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. 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.
  6. 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.
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