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Ask the Experts: Pneumococcal: Recommendations for Children

Results (10)

In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of Streptococcus pneumoniae and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten years later in February 2010, a new 13-valent product was licensed — PCV13 (Prevnar 13, Pfizer) — which added 6 new serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes account for the majority of invasive pneumococcal disease (IPD) in the U.S., including serotype 19A, which is the most common IPD-causing serotype in young children. In February 2010 ACIP recommended that healthcare providers transition from use of PCV7 to use of PCV13 for routine vaccination of children.

PCV7 was initially recommended for routine use in infants and children ages 2 through 59 months. The recommendations were expanded with the licensure of PCV13 to include vaccination of children age 60 through 71 months with underlying medical conditions, and also vaccination of older children, ages 6 through 18 years, with medical conditions placing them at increased risk of invasive pneumococcal disease.

Last reviewed: July 26, 2022

All infants should be given a primary series of PCV13, at ages 2, 4, and 6 months with a booster at age 12 to 15 months. Children who fall behind should be given catch-up vaccination through age 59 months, if otherwise healthy, or through age 71 months if they have certain underlying medical conditions.

For pneumococcal vaccination of children ages 2 through 5 years, see the CDC summary here:

Last reviewed: July 26, 2022

A single dose of PCV13 should be given to children ages 6 –18 years who have not received PCV13 before and have anatomic or functional asplenia (including sickle cell disease), immunocompromising conditions (such as HIV infection), cochlear implant, or cerebrospinal fluid (CSF) leaks. Routine use of PCV13 is not recommended for healthy children 5 years of age or older.

When elective splenectomy, immunocompromising therapy, or cochlear implant placement is being planned, PCV13 and/or PPSV23 vaccination (as needed) should be completed at least 2 weeks before surgery or initiation of therapy. For people not vaccinated 2 weeks prior, vaccinate as soon as possible.

For a complete explanation of pneumococcal vaccination recommendations for ages 6 through 18 years, CDC has summarized the recommendations here:

Last reviewed: July 26, 2022

All children should receive routine vaccination with PCV13 as age-appropriate. A child age 2 through 18 years should receive PPSV23 at least 8 weeks following the last recommended dose of PCV13 if they have any of the following conditions:

  1. alcoholism
  2. chronic liver disease, including cirrhosis
  3. chronic heart disease (e.g., congestive heart failure, cardiomyopathies), excluding hypertension
  4. chronic lung disease (including COPD and emphysema)
  5. diabetes mellitus
  6. candidate for or recipient of cochlear implant
  7. cerebrospinal fluid (CSF) leak
  8. functional or anatomic asplenia (e.g., splenectomy or congenital asplenia)
  9. sickle cell disease and other hemoglobinopathies
  10. congenital or acquired immunodeficiencies (e.g., B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4), and phagocytic disorders (excluding chronic granulomatous disease)
  11. generalized malignancy
  12. HIV infection
  13. Hodgkin’s disease, leukemia, lymphoma, and multiple myeloma
  14. immunosuppression due to treatment with medication, including long-term systemic corticosteroids, and radiation therapy
  15. solid organ transplantation; for bone marrow transplantation, see
  16. chronic renal failure or nephrotic syndrome
Last reviewed: July 26, 2022

All children 2-18 years who are at highest risk for serious pneumococcal infection (see categories 9 through 16 in related answer) should first be assessed and age-appropriately vaccinated with PCV13, if indicated. At least 8 weeks following completion of PCV13 vaccination, these children should get the first of 2 doses of PPSV23, spaced five years apart. Children with risk factors 1 through 8 above should get one dose of PPSV23.

Last reviewed: July 26, 2022

ACIP does not recommend routine PCV13 vaccination of healthy children 60 months of age or older. If there is a school requirement, the simplest solution is to give the child one dose of PCV13. However, health insurance may not pay for this dose. For more information on the ACIP recommendations for pneumococcal vaccination of children, go to CDC’s summary of pneumococcal vaccine recommendations:

Last reviewed: July 26, 2022

No. Currently no data exist to indicate that people younger than 19 who smoke are at increased risk of pneumococcal disease.

Last reviewed: July 26, 2022

PPSV23 is not effective in children less than 24 months of age. PPSV23 given to children younger than 2 years old should not be considered part of the pneumococcal vaccination series. PCV13 should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified.

Last reviewed: July 26, 2022

Yes. Selective IgA deficiency is a B-cell immunodeficiency, so PPSV23 is indicated if the child is age 2 years or older and already age-appropriately vaccinated with PCV13. If the child were not fully vaccinated with PCV13, the recommendation would have been to give her any recommended doses of PCV13 first, followed by PPSV23 at least 8 weeks later. PCV15 and PCV20 are not recommended for use in children at this time.

Last reviewed: July 26, 2022

A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. The risk for febrile seizures in children who received PCV15 or PCV20 concurrently with an influenza vaccine has not been studied. See for more information about febrile seizures after vaccination.

Last reviewed: September 10, 2023

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