Pneumococcal Vaccine Schedule: High Risk Pediatrics

PNEUMOCOCCAL VACCINE SCHEDULE: HIGH-RISK PEDIATRICS
Risk Group or Condition	Pneumococcal Vaccine Recommendations (2–18yrs)
	Age 2–5yrs			Age 6–18yrs
	PCV unvaccinated or incomplete PCV series¹	PCV series completed²	Complete PCV + PPSV23 vaccinated	PCV unvaccinated	PCV13 or PCV15 vaccinated (no PCV20)	PCV13 or PCV15 (no PCV20) + PPSV23 vaccinated
With Chronic Medical Conditions
Chronic heart disease³	PCV15 or PCV20 2 doses ≥8wks apart Missing 4^th dose only: PCV15 or PCV20 1 dose to complete series Previously received PCV20: No additional vaccine⁶	PCV20 included in the series: No additional vaccine⁶ Only PCV13 or PCV15 used in the series: PCV20 or PPSV23⁷ 1 dose ≥8wks after last PCV dose¹²	No additional vaccine⁶	PCV15 or PCV20 1 dose ≥8wks after last pneumococcal vaccine⁸ If PCV15 used, also give PPSV23 ≥8wks after the last PCV dose if not previously given	PCV20 or PPSV23 1 dose ≥8wks after last PCV dose¹²	No additional vaccine⁶
Chronic kidney disease⁴
Chronic liver disease
Chronic lung disease⁵
Diabetes mellitus
Cerebrospinal fluid leak
Cochlear implant
With Immunocompromising Conditions
Maintenance dialysis or with nephrotic syndrome	PCV15 or PCV20 2 doses ≥8wks apart Missing 4th dose only: PCV15 or PCV20 1 dose to complete series Previously received PCV20: No additional vaccine⁶	PCV20 included in the series: No additional vaccine⁶ Only PCV13 or PCV15 used in the series: PCV20¹⁰ or PPSV23⁷ 1 dose ≥8wks after last PCV dose. If PPSV23 used, revaccinate with 1 dose PCV20 or PPSV23 ≥5yrs after the first PPSV23 dose¹²	No additional vaccine at this time Revaccinate with 1 dose PCV20 or PPSV23 ≥5yrs after the first PPSV23 dose¹²	PCV15 or PCV20 1 dose ≥8wks after last pneumococcal vaccine⁸ If PCV15 used, also give PPSV23 ≥8wks after the last PCV dose if not previously given	PCV20¹⁰ or PPSV23⁷ 1 dose ≥8wks after last PCV dose. If PPSV23 used, revaccinate with 1 dose PCV20 or PPSV23 ≥5yrs after the first PPSV23 dose¹²	No additional vaccine at this time Revaccinate with 1 dose PCV20 or PPSV23 ≥5yrs after the first PPSV23 dose¹²
Congenital or acquired asplenia or splenic dysfunction
Congenital or acquired immunodeficiencies⁹
Conditions treated with immunosuppressants or radiation therapy¹¹
HIV infection
Sickle cell disease or other hemoglobinopathies
NOTES
Key: PCV = pneumococcal conjugate vaccine; PCV15 = 15-valent PCV; PCV20 = 20-valent PCV; PPSV23 = 23-valent pneumococcal polysaccharide vaccine ¹ Any incomplete PCV schedule with <3 doses before age 2yrs. ² Completed all recommended PCV doses before age 6yrs. ³ Especially in children with cyanotic congenital heart disease and cardiac failure. ⁴ Excludes maintenance dialysis and nephrotic syndrome. ⁵ Includes moderate persistent or severe persistent asthma. ⁶ Pneumococcal vaccines are complete. ⁷ Recommended for children aged ≥2yrs with no previous PCV20 vaccination. ⁸ Give dose regardless of whether the child has previously received PPSV23 or PCV7. ⁹ Includes B-(humoral) or T-lymphocyte deficiency, complement deficiencies particularly C1/C2/C3/C4 deficiency, phagocytic disorders (excluding chronic granulomatous disease). ¹⁰ If PCV20 is used, their vaccines are then complete. ¹¹ Includes malignant neoplasms, leukemias, lymphomas, Hodgkin disease, solid organ transplant. ¹² Regardless of vaccine used, their vaccines are then complete.
REFERENCE
Centers for Disease Control and Prevention. ACIP Updates: Recommendations for Use of 20-Valent Pneumococcal Conjugate Vaccine in Children — United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72:1072. DOI: http://dx.doi.org/10.15585/mmwr.mm7239a5 Centers for Disease Control and Prevention. Pneumococcal Vaccination: Summary of Who and When to Vaccinate. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html#children-6-18. Accessed March 19, 2024. Created 3/2024

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