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Resolution No. 06/23-2 

 

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 

VACCINES FOR CHILDREN PROGRAM 

VACCINES TO PREVENT PNEUMOCOCCAL DISEASE

 

The purpose of this resolution is to update recommendations regarding the use of pneumococcal 

conjugate vaccines (PCV) for children to include 20-valent PCV (PCV20) as an option. 

VFC resolution 06/22-1 is repealed and replaced by the following: 

A. Pneumococcal Conjugate Vaccine (PCV) to Prevent Pneumococcal 

Disease

Eligible groups 

• All children six weeks through 59 months of age 

• Children 5 through 18 years of age with certain underlying medical conditions that 

increase the risk of pneumococcal disease (hereafter, risk conditions) listed in Table 1 

Table 1. Risk conditions that are indications for pneumococcal vaccination among children 

Chronic medical 

conditions

Chronic heart disease*

Chronic kidney disease (excluding maintenance dialysis and 

nephrotic syndrome, which are included in 

immunocompromising conditions) 

Chronic liver disease

Chronic lung disease (including moderate persistent or severe 

persistent asthma)

Diabetes mellitus

Cerebrospinal fluid leak

Cochlear implant

Immunocompromising 

conditions

Sickle cell disease and other hemoglobinopathies

Congenital or acquired asplenia, or splenic dysfunction

HIV infection

On maintenance dialysis or nephrotic syndrome

Diseases associated with immunosuppressive chemotherapy, 

or radiation therapy including malignant neoplasms, 

leukemias, lymphomas and Hodgkin disease; or solid organ 

transplantation

Congenital or acquired immunodeficiency**

* Particularly cyanotic congenital heart disease and cardiac failure

** Includes B- (humoral) or T-lymphocyte deficiency; complement deficiencies, 

particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic 

granulomatous disease)
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Recommended Vaccine Schedule and Dosage Intervals

 

Table 2. Recommended schedules for administering doses of either 15-valent PCV (PCV15) or 

PCV20 among children who have not previously received PCV, and those incompletely 

vaccinated with PCV for age. 

Age Vaccination history: 

total number of PCV 

doses received 

previously

Recommended PCV Regimen1,2,3

2–6 mo 0 doses 3 doses, 8 weeks apart; fourth dose 

at age 12–15 mos 

1 dose 2 doses, 8 weeks apart; fourth dose 

at age 12–15 mos

2 doses 1 dose, 8 weeks after the most recent 

dose; fourth dose at age 12-15 mos

7–11mo 0 doses 2 doses, 8 weeks apart; third dose at 

12-15 mos 

1 or 2 doses before age 7 

mo

1 dose at age 7–11 mos; second dose 

at 12–15 mos (≥8 weeks later)

12–23 mo 0 doses 2 doses, ≥8 weeks apart

1 dose before age 12 mo 2 doses, ≥8 weeks apart

1 dose at ≥12 mo 1 dose, ≥8 weeks after the most recent dose

2 or 3 doses before age 12 mo 1 dose, ≥8 weeks after the most recent dose

24–59 mo

Healthy children Any incomplete schedule 1 dose, ≥8 weeks after the most recent dose

24-71 mo

Children with risk

conditions as defined 

in Table 14

Any incomplete schedule of 

<2 doses5

2 doses, one ≥8 weeks after the most recent 

dose and another dose ≥8 weeks later

3 doses, all given <12 months 1 dose, ≥8 weeks after the most recent dose

6-18 years

Children with risk 

conditions as defined 

in Table 14

0 doses 1 dose6
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Table notes: 

1) Either PCV15 or PCV20 may be used for the full series or to complete the recommended 

schedule begun with PCV13. 

2) If only 13-valent PCV (PCV13) is available when the child is scheduled to receive a PCV, 

PCV13 may be given as previously recommended. 

3) Minimum interval between doses is 8 weeks except for children vaccinated at age <1 year, 

for whom minimum interval between doses is 4 weeks.

4) For children with risk conditions (see Table 1), either PCV15 or PCV20 is indicated through 

18 years of age.

5) If a child received 2 doses of PCV between 12–23 months, the child has received a complete 

PCV schedule even though the total number of PCV doses received is 2. 

6) When PCV15 is used, it should be followed by a dose of 23-valent pneumococcal 

polysaccharide vaccine (PPSV23) ≥8 weeks after the PCV15 dose if not previously given. 

Recommended dosage 

Refer to product package inserts. 

Contraindications and Precautions

Contraindications and precautions can be found at: Vaccines Licensed for Use in the United 

States | FDA

B. Pneumococcal Polysaccharide Vaccine (PPSV23) to Prevent 

Pneumococcal Disease 

Eligible groups 

• Children aged 2 through 18 years with any risk condition as defined in Table 1

Recommended Vaccine Schedule and Dosage Intervals

See Table 2 (footnote 6) for children 2–18 years of age who received the recommended PCV 

dose at age ≥6 years.

Table 3. Schedule for vaccination for children 2–18 years of age with risk conditions** who 

have completed their recommended PCV doses before age 6 years. 

Group Schedule for PCV20 or 

PPSV23* 

Vaccination with PCV20 

or Revaccination with 

PPSV23

Children with risk

conditions who have 

received ≥1 dose of PCV20

Not indicated Not indicated

Children with chronic 

medical conditions** who 

have not received PCV20 

1 dose of PCV20 or 

PPSV23 administered at 

age >2 yrs, >8 weeks after 

last indicated dose of PCV

Not indicated
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Children with an 

immunocompromising 

condition** who have not 

received PCV20 (option1)

1 dose of PCV20 Not indicated

Children with an 

immunocompromising 

condition** who have not 

received PCV20 (option2)

1 dose of PPSV23 

administered at age >2 yrs, 

>8 weeks after last 

indicated dose of PCV

1 dose of PCV20 5 years 

after the first dose of 

PPSV23

Children with an 

immunocompromising 

condition** who have not 

received PCV20 (option3)

1 dose of PPSV23 

administered at age >2 yrs, 

>8 weeks after last 

indicated dose of PCV

1 dose PPSV23 5 years 

after the first dose of 

PPSV23

*Doses of PCV should be completed before PPSV23 is given. No more than two PPSV23 

doses are recommended. 

**See Table 1 for definitions of chronic medical and immunocompromising conditions. 

Recommended dosage 

Refer to product package inserts. 

Contraindications and Precautions

Contraindications and precautions can be found at: Vaccines Licensed for Use in the United 

States | FDA

[If an ACIP recommendation regarding pneumococcal vaccination is published within 12 

months following this resolution, the relevant language above (except in the eligible groups 

sections) will be replaced with the language in the recommendation and incorporated by 

reference to the publication URL.]

 

Adopted and Effective: June 22, 2023 

This document can be found on the CDC website at: 

ACIP Resolutions for Vaccines for Children (VFC) Program | CDC