A 3-year-old child who was fully vaccinated on-time with PCV13 has a diagnosis of selective IgA deficiency and was sent by her physician to the health department to receive additional pneumococcal vaccination. Does the child need additional pneumococcal vaccination? If so, what options do we have?

Selective IgA deficiency is a B-cell immunodeficiency, so additional pneumococcal vaccination beyond the routine age-based schedule is indicated for this 3-year-old with an immunocompromising condition. Because the child received a complete PCV13 series, the current recommendation is to administer a single dose of PCV20 or PPSV23 at least 8 weeks following the most recent PCV dose. If PCV20 is given, no further doses of pneumococcal vaccine are recommended. If PPSV23 is given now, then at least 5 years later give a dose of PCV20 or a second dose of PPSV23.