Administering Pneumococcal Vaccines

This page provides a brief summary of guidance for administering pneumococcal vaccines, including route, number of doses, and co-administration with other vaccines.

Visual Inspection

Do not use any pneumococcal vaccine beyond the expiration date printed on the label.

Prior to administration, visually inspect the vaccine for particulate matter and/or discoloration. If these conditions exist, do NOT use.

Route, Site, and Needle Size

Pneumococcal polysaccharide vaccine may be administered intramuscularly or subcutaneously, while pneumococcal conjugate vaccine is administered intramuscularly. The preferred site for infants and young children is the vastus lateralis muscle in the anterolateral thigh. The preferred injection site in older children and adults is the deltoid muscle. A needle length appropriate for the age and size of the person receiving the vaccine should be used.

Number and Timing of Doses

All children younger than 2 years old should be routinely vaccinated with pneumococcal conjugate vaccine (PCV13 or Prevnar13®). The primary series beginning in infancy consists of three doses routinely given at 2, 4, and 6 months of age. The first dose can be administered as early as 6 weeks of age. A fourth (booster) dose is recommended at 12 through 15 months of age. For children vaccinated at younger than 12 months of age, the minimum interval between doses is 4 weeks. Doses given at 12 months of age and older should be separated by at least 8 weeks.

Adults 65 years or older who have not previously received PCV13 or whose previous vaccination history is unknown should receive a dose of PCV13. A dose of pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) should be given at least 1 year after the dose of PCV13 for most immunocompetent adults and at least 8 weeks later for adults with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants.

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Predrawing Vaccine Doses

Predrawing vaccine doses is not recommended because there are no data on the stability of vaccines stored in syringes filled by healthcare professionals. Vaccine vials should not be opened until time of administration.

Administration with Other Vaccines

Pneumococcal conjugate and polysaccharide vaccines should never be administered during the same visit. If a patient needs both vaccines, you should administer a dose of pneumococcal conjugate vaccine (PCV13) first, followed by a dose of pneumococcal polysaccharide vaccine (PPSV23) at another visit. The interval between administrations depends on the age of the patient and which vaccine is administered first. See the table below for additional information.

Age Group	Interval Recommendation (PCV13 then PPSV23, preferred)	Interval Recommendation (PPSV23 then PCV13)
24 through 71 month olds	8 weeks or longer	8 weeks or longer
6 through 8 year olds	8 weeks or longer	8 weeks or longer
19 or older with certain medical conditions*	8 weeks or longer	1 year or longer
65 or older	1 year or longer	1 year or longer

* Medical conditions include cochlear implants, cerebrospinal fluid leaks, functional or anatomic asplenia, and immunocompromising conditions like HIV infection, cancer, or chronic renal failure.

For Kids

Generally, PCV13 and PPSV23 can be administered at the same time as most other routine childhood vaccinations if administered in a separate syringe at a separate injection site; exceptions include:

• PCV13 should not be given with Menactra®, a meningococcal conjugate vaccine. Children with functional or anatomic asplenia are NOT recommended to receive Menactra® until 2 years of age in order to avoid interference with the immunologic response to the infant series of PCV13. CDC recommends that infants 2 through 23 months of age with functional or anatomic asplenia either receive Menveo® or MenHibrix® or wait until 2 years of age to receive Menactra®.
• There is an increased risk for febrile seizures when influenza vaccine is given around the same time as PCV13 and DTaP vaccines in children. A recent Vaccination Safety Datalink study took a closer look at the 2010/2011 febrile seizure signal for trivalent inactivated influenza vaccine (TIV or IIV) and PCV13. The study included the 2006–2009 seasons in addition to the 2010–2011 influenza season. The findings showed that PCV13 and diphtheria, tetanus, and acellular pertussis vaccine (DTaP) both increase risk of febrile seizure when given at the same time as the influenza vaccine. CDC found that when TIV was given alone, it was not associated with an increased risk of febrile seizures (in the influenza seasons studied).

PCV13 has been administered concurrently with vaccines containing the following antigens with no adverse effects on immunogenicity or safety: diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, inactivated poliomyelitis, rotavirus, hepatitis B, meningococcal serogroup C, measles, mumps, rubella, and varicella.

Currently, no data from clinical trials are available for co-administration of PPSV23 with other childhood vaccines during the same visit.

For Adults

In adults, either pneumococcal vaccine (PCV13 or PPSV23) can be administered during the same visit with influenza vaccination, but at a different injection site, if feasible. Each vaccine should be administered with a separate syringe. In addition to preventing the flu, annual influenza vaccination is important because having the flu increases a person’s chances of getting pneumococcal disease.

• A randomized double-blind trial with adults 65 years old or older found that concomitant administration of PCV13 and trivalent inactivated influenza vaccine (TIV) produced a reduced immune response for some pneumococcal serotypes and one influenza subtypes (influenza A [H3N2]) compared to individuals who received PCV13 alone or TIV alone. However, concomitant administration of PCV13 and trivalent inactivated influenza vaccine (TIV) has been demonstrated to be immunogenic and safe. PCV13 can be administered during the same visit with TIV in an adult immunization program.
• Currently, no data are available on administration of PCV13 during the same visit with other vaccines (e.g., tetanus, diphtheria, and acellular pertussis vaccine or zoster vaccine) among adults.
• A randomized clinical study found that concomitant administration of PPSV23 and zoster vaccine produced a reduced immune response to zoster compared with individuals who received these vaccines 4 weeks apart. However, to avoid introducing barriers to vaccination, CDC continues to recommend that zoster vaccine and PPSV23 be administered at the same visit if the person is eligible for both vaccines.

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