Although you’ve been administering pneumococcal vaccines in your practice for decades, new products and evolving recommendations are leading to changes in practice implementation. 


Pneumococcal Overview 

Streptococcus pneumoniae bacteria can lead to pneumococcal infections that vary in severity, from acute otitis media and sinusitis to periorbital cellulitis and bacterial meningitis.  

The United States has seen a dramatic decline in invasive pneumococcal disease in both children and adults since the introduction of pneumococcal conjugate vaccines (PCV), which were first recommended in 2000 (polysaccharide pneumococcal vaccine [PPSV] has been available since 1983). 


AAP Recommendations

The AAP recommends routine pneumococcal vaccine for all infants and children 2 through 59 months of age. Depending on the vaccine(s) given, an additional dose may be recommended for children with high-risk conditions. See the AAP Red Book Online for recommendations.


June 2023 Guidance Changes  

PCV 20 was recommended as an option for routine pneumococcal vaccination in children in the 4 scenarios below. The AAP and CDC support these recommendations and inclusion of PCV20 as outlined in the AAP Red Book Online and Vaccine Status Table. 

  1. Routine use: Children ages 2-23 months should receive either PCV15 or PCV20 according to recommended dosing and schedules.
  2. Catch-up vaccination: Healthy children ages 24 – 59 months with incomplete PCV vaccination status and children ages 24 – 71 months with certain underlying conditions and an incomplete PCV vaccination status should receive either PCV15 or PCV20 according to currently recommended dosing and schedules.
  3. Children ages 2 – 18 years with any risk condition who have received all recommended doses before age 6 years do not need additional doses if they have received at least one dose of PCV20. If they received PCV13 or PCV15 but not PCV20, they should receive a dose of PCV20 or pneumococcal polysaccharide vaccine (PPSV23) using the previously recommended doses and schedule.
  4. Children ages 6 – 18 years with any risk condition who have not received any dose of PCV13, PCV15 or PCV20 should receive a single dose of PCV15 or PCV20. When PCV15 is used, it should be followed by a dose of PPSV23 at least eight weeks later if not previously given. 

The CDC also expanded its definition of high-risk children to include:

  • Moderate persistent and severe persistent asthma  
    • Moderate persistent asthma characteristics include: symptoms occur daily; flare-ups occur and usually last several days; coughing and wheezing may disrupt the child’s normal activities and make it difficult to sleep; nighttime flare-ups may occur more than once a week; lung function is roughly between 60% and 80% of normal without treatment.
    • Severe persistent asthma characteristics include: symptoms occur daily and often; symptoms frequently curtail the child’s activities or disrupt their sleep; lung function is less than 60% of the normal level without treatment.  
  • Chronic liver disease
  • Chronic kidney diseases (excluding maintenance dialysis and nephrotic syndrome, which are included in immunocompromising conditions)  


More About the Pneumococcal Vaccines

There are 3 Food and Drug Administration (FDA)-approved vaccines currently available and recommended in the US for use in children for the protection against invasive pneumococcal disease. 



Tools and Resources for Pediatricians 

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American Academy of Pediatrics