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Pneumococcal vaccination for immune-compromised children age 6 through 18 years who are at high risk for invasive pneumococcal disease

Pneumococcal vaccination for immune-compromised children age 6 through 18 years who are at high risk for invasive pneumococcal disease
This algorithm is intended for use with UpToDate content on pneumococcal vaccination in children. Please refer to UpToDate content for additional details regarding vaccine administration. Doses of PCV13/PCV15 and PPSV23 should be separated by ≥8 weeks.

PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine; IPD: invasive pneumococcal disease.

* High-dose oral glucocorticoid therapy is defined as ≥20 mg per day of prednisone or equivalent for ≥14 days.

¶ PCV13 and PCV15 can be used interchangeably.

Δ Most experts recommend that the second dose of PPSV23 be administered at least 5 years after the first. However, for children with sickle cell disease, some experts recommend an interval of 3 years between the first and second PPSV23. Refer to UpToDate content on management of sickle cell disease for details. The United States Advisory Committee on Immunization Practices recommends a total of two doses of PPSV23 for immunocompromised children at high risk for IPD, including asplenia. However, other experts suggest that individuals with asplenia receive PPSV23 every 5 years. Refer to UpToDate content on prevention of sepsis in the asplenic patient for additional information.
Data from:
  1. 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.
  2. 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.
  3. 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.
  4. Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2022. Available at: www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed on September 26, 2022.
  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.
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