Questions & Answers

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When did pneumococcal vaccine become available?
There are two types of pneumococcal vaccine — pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine. The first pneumococcal polysaccharide vaccine, containing 14 serotypes, was licensed in the United States in 1977. In 1983, an improved pneumococcal polysaccharide vaccine was licensed, containing purified protein from 23 types of pneumococcal bacteria. This pneumococcal polysaccharide vaccine is commonly known as PPSV23. The PPSV23 vaccine is licensed for routine use in adults 65 years and older and persons with certain risk factors who are age 2–49 years.

The first pneumococcal conjugate vaccine, PCV7, was licensed in early 2000. Ten years later, in 2010, a new pneumococcal conjugate vaccine product (PCV13) was licensed and replaced PCV7 for use in the routine vaccination of children. PCV13 offers additional protection against the types of pneumococcal bacteria that cause the majority of invasive pneumococcal disease in the Unites States. PCV13 is recommended for use in preventing pneumococcal disease in infants and young children, beginning as young as 6 weeks.

What kind of vaccines are they?
Both pneumococcal vaccines are made from inactivated (killed) bacteria. The pneumococcal polysaccharide vaccine (PPSV23) contains long chains of polysaccharide (sugar) molecules that make up the surface capsule of the bacteria. Generally speaking, a pure polysaccharide vaccine induces only short-term immunity and doesn’t work as well in children younger than 2 years. The pneumococcal conjugate vaccine includes purified capsular polysaccharides from the bacteria that are "conjugated" (or joined) to a harmless variety of diphtheria toxin. The resultant conjugate vaccine is able to produce an immune response in infants and antibody booster response to multiple doses of vaccine.

How is this vaccine given?
The polysaccharide vaccine (PPSV23) can be given as a shot in either the muscle or the fatty tissue of the arm or leg. The conjugate vaccine (PCV13) is given as a shot in the muscle.

What is the schedule for the routine doses of PCV13 for children?
All infants and toddlers should get four doses of PCV13 vaccine, usually given at ages two, four, six, and 12–15 months.

Can older children be given PCV13?
Yes, this option includes children ages 6 through 18 years who are at increased risk for pneumococcal disease because of sickle cell disease, HIV infection, or other immunocompromising condition; have a cochlear implant (a surgically implanted device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing); or have a cerebrospinal fluid leak. These children may get a single dose of PCV13 regardless of their history with PCV7 or PPSV23.

What if my three-year-old child never got his PCV13 shots?
The number of doses a child needs to complete the series depends on his or her current age. Older children need fewer doses. For example, a healthy unvaccinated child age 24–59 months needs a single dose of PCV13. Your healthcare provider can tell you how many doses are needed to complete the series at a certain age. PCV13 is not routinely recommended for individuals who are age five years or older.

Do some children need to get both PCV13 and PPSV23?
Yes, children at high risk of invasive pneumococcal disease should receive PCV13 and then also receive PPSV23 when age two years or older. PPSV23 is not given routinely to healthy children. You can find more information about pneumococcal vaccination schedules for children at www.immunize.org/catg.d/p2016.pdf

If influenza is recommended for healthcare workers to protect high-risk patients from getting influenza, why isn't pneumococcal vaccine also recommended?
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than just having the bacteria in one's nose or throat.

My elderly neighbor got a second pneumococcal shot. I thought just one was required.
Vaccination is not done routinely, but a single revaccination dose is recommended for groups of people at highest risk of serious infection. No one should receive more than two doses of PPSV23.

For example, persons who received a first dose when they were younger than age 65 years should receive a second dose at age 65 years if at least five years have elapsed since the previous dose. Likewise, persons age two years or older who are at high risk for pneumococcal disease due to certain long-term health problems, in particular immunosuppression, HIV infection, and not having a functional spleen (or having no spleen) should get a second dose five or more years after the first dose.

Anyone interested in the full list of recommendations for revaccination with PPSV23 can find a chart at www.immunize.org/catg.d/p2015.pdf

Who recommends pneumococcal vaccines?
The Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices recommend routine vaccination for infants and young children with PCV13 vaccine. The Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American College of Physicians all recommend the PPSV23 vaccine.

Should all nursing home patients ages 65 years and older be vaccinated against pneumococcal disease?
Yes.

Can pregnant women get this vaccine?
The safety of PPSV23 vaccine for pregnant women has not been studied, although no adverse consequences have been reported among newborns whose mothers were vaccinated with pneumococcal polysaccharide vaccine during pregnancy. Women who are at high risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible. Unvaccinated pregnant women who are in a high-risk group should consult with a healthcare professional about getting the vaccination during pregnancy.

How safe is this vaccine?
PPSV23 and PCV13 are both very safe vaccines.

For PPSV23, about 30%–50% of the people who get the vaccine have very mild side effects, such as redness or pain where the shot was given. Fewer than 1% of recipients develop a fever, muscle aches, or more severe local reactions. Serious allergic reactions have been reported very rarely. Data from the clinical trials for PCV13 showed similar results as for PCV7. Most reactions were mild and, on average, about half of the children were drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where the shot was given. About 1 out of 3 had swelling where the shot was given, about 1 of 3 had a mild fever, about 1 in 20 had a higher fever (over 102oF), and about 8 out of 10 became fussy or irritable.

How effective is pneumococcal polysaccharide vaccine (PPSV23)?
Overall, PPSV23 is 60%–70% effective in preventing invasive disease. Older adults (e.g., older than age 65 years) and persons with significant underlying illnesses do not respond as well, but vaccination with PPSV23 is still recommended because such persons are at high risk of developing severe pneumococcal disease.

Questions and answers about pneumococcal disease

Technically reviewed by the Centers for Disease Control and Prevention, August 2010