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Summary of pneumococcal immunisation policy

  • Pneumococcal vaccine is recommended for:
    • infants as part of the routine childhood immunisation programme
    • all those aged 65 years and over
    • all those aged 2 months and over in the clinical risk groups as set out in the table
  • Previously unvaccinated children and adults requiring splenectomy or commencing immunosuppressive treatment may be at an increased risk of pneumococcal disease and should be vaccinated according to the schedule for this specific risk group
  • There are two types of pneumococcal vaccine—23-valent pneumococcal polysaccharide vaccine (PPV) and 13-valent pneumococcal conjugate vaccine (PCV)
  • Primary care staff should identify patients for whom vaccine is recommended and use all opportunities to ensure that they are appropriately immunised, for example:
    • when immunising against influenza
    • at other routine consultations, especially on discharge after hospital admission
  • Most healthy adults develop a good antibody response to a single dose of polysaccharide vaccine by the third week following immunisation
  • Children younger than two years of age show poor antibody responses to immunisation with the polysaccharide vaccine. The antibody response in young children can be improved by conjugating the polysaccharide to proteins such as CRM197. The conjugated vaccine is immunogenic in children from two months of age
  • Children and adults with cochlear implant may be at increased risk of pneumococcal infection and are therefore recommended pneumococcal vaccination
    • where possible, pneumococcal vaccination should be completed at least 2 weeks prior to surgery to allow a protective immune response to develop
    • in some cases it will not be possible to complete the course prior to surgery. In this instance, the course should be started at any time prior to or following surgery and completed according to the immunisation schedule
Asplenia or dysfunction of the spleen This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction
Chronic respiratory disease This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children with respiratory conditions caused by aspiration, or a neuromuscular disease (e.g. cerebral palsy) with a risk of aspiration. Asthma is not an indication, unless so severe as to require continuous or frequently repeated use of systemic steroids (as defined in Immunosuppression below)
Chronic heart disease This includes those requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure
Chronic kidney disease Nephrotic syndrome, chronic kidney disease at stages 4 and 5 and those on kidney dialysis or with kidney transplantation
Chronic liver disease This includes cirrhosis, biliary atresia and chronic hepatitis
Diabetes Diabetes mellitus requiring insulin or oral hypoglycaemic drugs. This does not include diabetes that is diet controlled
Immunosuppression Due to disease or treatment, including asplenia or splenic dysfunction and HIV infection at all stages. Patients undergoing chemotherapy leading to immunosuppression. Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20 mg or more per day (any age), or for children under 20 kg, a dose of 1 mg or more per kg per day. However, some immunocompromised patients may have a suboptimal immunological response to the vaccine
Individuals with cochlear implants It is important that immunisation does not delay the cochlear implantation
Individuals with cerebrospinal fluid leaks This includes leakage of cerebrospinal fluid such as following trauma or major skull surgery

Immunisation schedule

  • Children aged 2 months to under 5 years of age should be vaccinated according to the schedule as set out in the table
  • For individuals aged five years and above, including those aged 65 years and over, a single dose of 23-valent pneumococcal polysaccharide vaccine is recommended. The vaccine can be offered throughout the year
  • Re-immunisation with this vaccine is not currently recommended for most people
  • Re-immunisation is only recommended after 5 years for people whose antibody levels are likely to have declined more rapidly (e.g. those with no spleen, with splenic dysfunction or with chronic kidney disease)
At-risk children 2 months to under 12 months of age Vaccination according to the routine immunisation schedule at 2, 4 and between 12 and 13 months of age (i.e. within a month of the first birthday) One dose after the second birthday
At-risk children 2 months to under 12 months of age who have asplenia or splenic dysfunction or who are immunosuppressed Vaccination according to the routine immunisation schedule at 2, 4 and between 12 and 13 months of age (i.e. within a month of the first birthday) One dose after the second birthday
At-risk children 12 months to under 5 years of age One dose One dose after the second birthday and at least 2 months after the final dose of PCV
At-risk children 12 months to under 5 years of age who have asplenia or splenic dysfunction or who are immunosuppressed Two doses, with an interval of 2 months between doses One dose after the second birthday and at least 2 months after the final dose of PCV
At-risk children aged over 5 years and at-risk adults PCV is not recommended One dose

Vaccine supply

  • The 13-valent PCV is manufactured by Pfizer (Medical Information tel: 01737 331111; fax: 01737 332507; email: MedInfoUK@Pfizer.com). It is supplied by Movianto UK Ltd (01234 248631) as part of the national childhood immunisation programme
  • The 23-valent plain PPV is manufactured by Sanofi Pasteur MSD (Tel: 0800 085 5511; Fax: 0800 085 8958)

Presentation and storage

  • Both types of pneumococcal vaccine are supplied in single dose vials of 0.5 ml. These vaccines should be stored unopened at +2°C to +8°C and protected from light
  • If the vaccine has been frozen, it should not be used. These vaccines are used as supplied, no dilution or reconstitution is necessary
  • The polysaccharide vaccine should be inspected before use to check that it is a clear, colourless solution
  • During storage of the conjugate vaccine, a white deposit and clear supernatant can exist. The vaccine should be shaken well to obtain a homogeneous white suspension and not be used if it contains any particulate matter

Dosage and administration

  • The method of administration of the pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine are the same. A single dose of 0.5 ml should be given im preferably into the upper arm or anterolateral thigh in infants under one year of age
  • The vaccines must not be given iv
  • Intradermal injection may cause a severe local reaction and is not recommended
  • For individuals with a bleeding disorder, vaccines should be given by deep sc injection
  • The vaccines can be given at the same time as other vaccines such as influenza and routine childhood vaccines. They should not be mixed with other concurrently administered vaccines. The vaccines should be given at a different site, preferably in a different limb

Adverse reactions

  • Mild soreness and induration at the site of injection and, less commonly, a low grade fever may occur


  • There are very few individuals who cannot receive pneumococcal vaccines.When there is doubt, appropriate advice should be sought from a consultant paediatrician, immunisation co-ordinator or consultant in communicable disease control rather than withholding the vaccine
  • The vaccines should not be given to those who have had:
    • a confirmed anaphylactic reaction to a previous dose of the vaccines
    • a confirmed anaphylactic reaction to any component of the vaccines

Further information

  • Additional pneumococcal resources can be ordered from Department of Health Publications (dh@prolog.uk.com; tel: 0870 1555 455; PO Box 777, London SE1 6XH)

full guidelines available from…
Immunisation Policy, Monitoring and Surveillance, Department of Health, Wellington House, 133–155 Waterloo Road, London SE1 8UG

Department of Health. Immunisation against infectious disease—The Green Book. Chapter 25 Pneumococcal 
First included: June 2005.