When both a pneumococcal conjugate vaccine (PCV) and PPSV23 are to be administered, PCV is always recommended to be given before PPSV23, based on studies demonstrating a better response to serotypes common to both vaccines when PCV was given first. These vaccines should not be given at the same visit. The routine interval between PCV and PPSV23 is one year; however, the minimum interval between PCV and PPSV23 of 8 weeks may be used when protection from pneumococcal serotypes unique to PPSV23 is required quickly (e.g., due to a high-risk condition such as asplenia).
Ask the Experts: Pneumococcal: Scheduling & Documentation
No, PCV15 and PPSV23 vaccines should not be given at the same visit. When administering PCV15 followed by PPSV23, give PCV15 first followed by PPSV23 one year later. Providers can consider a minimum interval of 8 weeks later for people with immunocompromising conditions, CSF leaks, or cochlear implants who may benefit from more rapid protection against serotypes unique to PPSV23.
If a patient inadvertently received PPSV23 before PCV15, an interval of at least 1 year between doses is recommended and a shorter interval is not recommended.
Give PCV13 followed by PPSV23 at least 8 weeks later. PCV13 and PPSV23 should not be given at the same visit. If a child has already received PPSV23, wait 8 weeks before giving PCV13.
PCV vaccines and PPSV23 should not be administered at the same visit or at an interval less than 8 weeks.
In children, if PCV13 and PPSV23 are administered at the same visit, the PCV13 dose should be repeated, and should be administered no earlier than 8 weeks after doses that were administered on the same day. However, in adults, if a PCV and PPSV23 are administered at the same visit or at an interval less than 8 weeks, CDC recommends that neither dose needs to be repeated.
Even though the interval was shorter than the recommended one year, the dose of PPSV23 should be counted and does not need to be repeated. In the future, please note the ACIP recommends that the routinely recommended interval between PCV13 or PCV15 and PPSV23 is 1 year, and the minimum interval is 8 weeks.
What to do when doses of PCV15 and PPSV23 are given without the recommended minimum interval between them is not described in the ACIP pneumococcal recommendations. The CDC subject matter experts have provided the following guidance: in such a case, the dose given second does not need to be repeated. This is an exception to the usual procedure for a minimum interval violation (as described in ACIP’s “General Best Practices Guidelines for Immunization”). The recommended interval between the dose of PCV15 and PPSV23 is one year and the recommended minimum interval between doses is 8 weeks.
When PCV15 is given to an adult 65 years or older, PCV15 should be given first followed by PPSV23 one year later (an 8-week minimum interval may be considered for immunocompromised recipients).
What to do when doses of PPSV23 and PCV15 are given without the recommended minimum interval is not addressed in the ACIP recommendations. The CDC subject matter experts have advised that in such a case, the dose given second does not need to be repeated. This is an exception to the usual procedure for a minimum interval violation as described in ACIP’s “General Best Practices Guidelines for Immunization” (see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html). There is no evidence to support that there are benefits to repeating the dose of PCV15.
In this case, refer to where the patient may receive either PCV20 alone or PCV15 with plans to receive PPSV23 one year later. ACIP recommends that pneumococcal conjugate vaccine be administered before PPSV23 for optimal immune response to vaccination. If there is a challenge in finding another provider who has PCV15 or PCV20 then administer PPSV23; it is better to give PPSV23 then nothing at all.
Yes. If patients have an uncertain vaccination history and their records are not readily obtainable, you should administer the recommended doses: PCV20 alone or PCV15 followed by PPSV23 one year later. Extra doses will not cause harm to the patient. Per the CDC “General Best Practices for Immunization Guidelines”, self-reported doses of influenza and PPSV23 are acceptable. Therefore, if a patient recalls receiving PPSV23, it is acceptable to provide one dose of PCV20 or one dose of PCV15.
No. However, this person should receive PCV15 or PCV20 one year after PPSV23 if they have no history or an unknown history of receiving a pneumococcal conjugate vaccine in the past.
It is preferable that the person planning to have the procedure be protected from pneumococcus at the time of the surgery; if possible, administer the appropriate vaccine prior to the splenectomy or cochlear implant. If the procedure is done on an emergency basis, vaccinate as soon as possible after surgery. Adults who have not previously received any pneumococcal vaccine should receive either PCV20 alone or PCV15 followed by PPSV23 at least 8 weeks later.
PCV15 and PCV20 are not licensed or recommended for children younger than 19 years at this time. Children 2 through 71 months of age who are up to date on PCV13 should continue to receive PPSV23 vaccine according to the schedule. They are recommended to receive a second dose of PPSV23 5 years after the first PPSV23 and at least 1 year after their most recent dose of PCV13.
Pneumococcal conjugate vaccines, Haemophilus influenzae type b vaccine, meningococcal ACWY conjugate vaccine, and meningococcal B vaccine should be given at least 14 days before splenectomy, if possible. Doses given during the 2 weeks (14 days) before surgery can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient’s condition has stabilized after surgery. Pneumococcal polysaccharide vaccine should be administered 8 weeks after the dose of PCV13 for people 2-18 years of age or after PCV15 for people 19 years or older. People age 19 or older who receive PCV20 do not need PPSV23.
All children with risk factors for pneumococcal disease or its complications should be vaccinated with PPSV23 beginning at age 2 years. If they are age-eligible and are due for a dose of PCV13, give PCV13 first and then wait 8 weeks before giving PPSV23. For more information on vaccination of high-risk pediatric patients, see pages 26–27 of the ACIP statement at www.cdc.gov/mmwr/pdf/rr/rr5911.pdf.
No. Only certain high-risk people who were vaccinated with PCV13 and PPSV23 when younger than age 65 years will need a second dose of PPSV23 5 years later. At age 65 years or older, all adults with no or unknown history of PCV vaccination are now recommended to have either a single dose of PCV20 alone or a dose of PCV15 followed by a dose of PPSV23 one year later.
For people 65 and older who have had a prior PCV13 vaccine, then CDC recommends a single dose of PPSV23 at least one year after PCV13 (and at least 5 years after any prior PPSV23 dose given before age 65 years). If PPSV23 is unavailable at the time vaccination is due, but PCV20 is available, PCV20 may be administered instead of PPSV23.
Yes, depending on the brand you use. If you are using Menveo (MenACWY-CRM, GSK) or MenQuadfi (MenACWY-TT, Sanofi Pasteur), they may be administered at the same time as PCV13 or at any interval before or after receipt of PCV13. If you are going to give him Menactra (MenACWY-D, Sanofi Pasteur), you need to wait at least 4 weeks after he completes the PCV13 series before giving him the Menactra to avoid the possibility of interference with the immune response to PCV13.
No, but the PPSV23 will render the PCV13 dose less immunogenic. Recommendations to separate MenACWY and PCV13 only apply to people with functional or anatomic asplenia or HIV (see next question). In this scenario, the best schedule is to give MenACWY (any brand) simultaneously with PCV13, and then PPSV23 in eight weeks. ACIP recommends giving PCV13 before PPSV23 in order to maximize the immune response from PCV13. PPSV23 may blunt the immune response to PCV13 if PCV13 is given after PPSV23, although in children there is a smaller effect than in adults. A 10-year-old with persistent complement component deficiency should also receive a 2 or 3 dose series (depending on brand) of meningococcal B vaccine.
Yes, with several exceptions. These are all inactivated vaccines, which means you can give all other recommended vaccines at the same visit (using separate syringes) or at any later time with no waiting period following the vaccination. Here are the exceptions:
- You cannot give both PCV and PPSV23 vaccines at the same time.
- If the person has functional or anatomic asplenia or HIV infection, observe these rules:
- If using Menveo (MenACWY-CRM) or MenQuadfi (MenACWY-TT) you may give PCV at the same visit or at any interval before or after each other.
- If using Menactra (MenACWY-D) vaccine, you should give PCV first and wait 4 weeks after the final dose of PCV before giving Menactra.
No. The available data have been interpreted that any changes in antibody response to either vaccine’s components were clinically insignificant. If PCV20 and influenza vaccine are both indicated and recommended they should be administered at the same visit.