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 PCV13 in 8 weeks, will the PCV13 interfere with the efficacy of the PPSV23 or the MenACWY?

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.