We have a 10-year-old getting renal dialysis. There is no history of previous PCV13 administration. The nephrologist will be starting her on a monoclonal antibody that interferes with C5 complement. If we administer meningococcal conjugate (MenACWY) and a PPSV23 now, and then give her a PCV15 in 8 weeks, will the PCV15 interfere with the efficacy of the PPSV23 or the MenACWY?

No, but the PPSV23 will render the PCV15 dose less immunogenic. In this scenario, the best schedule is to give a MenACWY vaccination (any brand) simultaneously with either PCV15 or PCV20. If PCV20 is given, no additional pneumococcal vaccine doses are recommended. If PCV15 is given, then PPSV23 should be given at least eight weeks later. ACIP recommends giving PCV before PPSV23 in order to maximize the immune response to PCV. PPSV23 may blunt the immune response to the serotypes contained in PCV if PCV is given after PPSV23, although in children there is a smaller effect than in adults. PCV21 (Capvaxive, Merck) is not an option because it is not licensed or recommended for use in children. Note that a 10-year-old child with persistent complement component deficiency should also be vaccinated against meningococcal B disease.