Issue 1759: May 30, 2024

Ask the Experts: Answers Questions about Pneumococcal Vaccination of Children

As an additional service to IZ Express readers, we periodically publish special editions such as this one, providing you with new and updated Ask the Experts questions and answers from experts. This issue includes 10 Q&As based on recent updates to CDC clinical guidance and ACIP recommendations for the vaccination of children against pneumococcal disease using pneumococcal conjugate vaccines (PCV13, PCV15, or PCV20) and, sometimes, 23-valent pneumococcal polysaccharide vaccine (PPSV23).
You can find all of these questions and answers, plus more than 1,300 others about vaccines and vaccine administration, on our "Ask the Experts" main page at's team of experts includes Kelly L. Moore, MD, MPH (team lead); Carolyn B. Bridges, MD, FACP; Iyabode Beysolow, MD, MPH; and Jane R. Zucker, MD, MPH.
Pneumococcal Vaccination of Children

Pneumococcal Vaccination of Children

Q: What are the major changes in the ACIP recommendations for pneumococcal vaccination of children published by CDC on September 29, 2023?

A: Both PCV15 and PCV20 are now recommended as pneumococcal vaccination options for children age 6 weeks and older as well as for older children age 6 through 18 years with certain medical conditions or other risk factors for pneumococcal disease. ACIP no longer recommends PCV13 for children or adults; however, PCV13 may be given as previously recommended if it is the only PCV available and the recipient would otherwise go without vaccination. Pneumococcal polysaccharide vaccine (PPSV23) is recommended as an option for some children age 2 years and older who have certain underlying medical conditions and who have not had (or do not have the option of receiving) PCV20.
Details of the recommendations can be found in the ACIP recommendations at (for PCV20) and (for PCV15). These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at:

A summary of these recommendations can also be found at has developed standing orders for pneumococcal vaccination of children and teens at

Q: What are the main differences between pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccines (PCVs)?

A: The polysaccharide vaccine includes the different polysaccharides (chains of complex sugars) from different serotypes as the antigen. The conjugate vaccines have the polysaccharides for different serotypes attached (or conjugated) to a carrier protein. The immune response to the PPSV23 vaccine is a T-cell independent immune response, while the immune response to PCV vaccination is a T-cell dependent response that produces memory B-cells and reduces carriage of the bacteria in the respiratory track. The PPSV23 does not reduce bacterial carriage.

Q: When is pneumococcal polysaccharide vaccine (PPSV23) recommended as an option for children?

A: PPSV23 has only limited indications in children age 2 through 18 years who have not had PCV20 and are at high risk for serious pneumococcal infection due to the presence of a specific non-immunocompromising (non-IC) or immunocompromising (IC) medical condition.
If PCV20 is not offered, PPSV23 is recommended as an option to be administered to a child age 2 years or older at least 8 weeks following completion of PCV vaccination with PCV13 or PCV15. If a child has an immunocompromising condition and PPSV23 is used, a dose of PCV20, or a second dose of PPSV23, should be given 5 years later. details all recommendations and pneumococcal vaccine options for children with high-risk conditions in its standing order template for pneumococcal vaccination of children and teens ( and its shorter resource, Recommendations for Pneumococcal Vaccines Use in Children and Teens (

Q: How do we account for the history of PCV7 vaccination when determining the pneumococcal vaccination needs of an older teen or young adult with a high-risk condition?

A: Because of the limited number of serogroups covered by PCV7 (which was used in the United States between 2000 and 2010), CDC recommends that doses of PCV7 should be ignored for the purposes of calculating the current pneumococcal vaccination needs of an older teen or adult patient at increased risk for pneumococcal disease. For example, a person at high risk of pneumococcal disease who received a complete series of PCV7 vaccination in early childhood should follow the vaccination recommendations for someone with their condition who has not received any doses of pneumococcal conjugate vaccine.

Q: ACIP recommends pneumococcal vaccination for adult cigarette smokers age 19 through 64 years. Should we also vaccinate 16-year-olds who smoke?

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

Q: Does a patient younger than age 65 years who smokes marijuana regularly, but doesn’t smoke cigarettes, need to receive pneumococcal vaccination?

A: No. ACIP does not designate people who smoke marijuana, but not cigarettes, as being in a risk group for vaccination. ACIP has not been presented evidence of an increased risk of pneumococcal disease among regular marijuana smokers.

Q: A healthy 3-year-old child in my practice was fully vaccinated on-time with PCV13. Do they need a dose of PCV15 or PCV20?

A: No. No additional doses of pneumococcal vaccine are recommended.

Q: Children in my practice have started the pneumococcal vaccine series with PCV13. Now that PCV15 or PCV20 are recommended, do I need to restart the vaccination series or give additional vaccine doses to all of them?

A: Do not restart the series or give additional doses. The previously administered doses of PCV13 are valid. Complete the pneumococcal conjugate vaccination series with either PCV15 or PCV20 in accordance with the routine schedule.

Q: My patient has had laboratory-confirmed pneumococcal pneumonia. Does this patient still need to be vaccinated against pneumococcal disease?

A: Yes. There are more than 100 known serotypes of pneumococcus. Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, they should receive it even after one or more episodes of pneumococcal disease.

Q: Pneumococcal vaccination schedules for children and adults are so complicated! What resources can help me determine what pneumococcal vaccination to give my patient and when?

A: Pneumococcal vaccination recommendations are complex, especially as newer conjugate vaccines are licensed and added to recommended options. Assessing what is needed for an individual patient of any age requires their age, pneumococcal vaccination history, and knowledge of any relevant high-risk conditions. There are several resources available from CDC and that can help:

CDC Resources: Resources:
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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
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    Laurel H. Wood, MPA
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    Kayla Ohlde

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