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This section is part 5 of the PHE pneumococcal guideline summary.

Contents included in this summary


Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation should be postponed until they have fully recovered. This is to avoid confusing the differential diagnosis of any acute illness by wrongly attributing any signs or symptoms to the adverse effects of the vaccine.

Pregnancy and breast-feeding

Pneumococcal vaccines may be given to pregnant women when the need for protection is required without delay. There is no evidence of risk from vaccinating pregnant women or those who are breast-feeding with inactivated viral or bacterial vaccines or toxoids.

Premature infants

It is important that premature infants have their immunisations at the appropriate chronological age, according to the schedule. The occurrence of apnoea following vaccination is especially increased in infants who were born very prematurely.

Very premature infants (born ≤ 28 weeks of gestation) who are in hospital should have respiratory monitoring for 48–72 hrs when given their first immunisation, particularly those with a previous history of respiratory immaturity. If the child has apnoea, bradycardia or desaturations after the first immunisation, the second immunisation should also be given in hospital, with respiratory monitoring for 48–72 hours.

As the benefit of vaccination is high in this group of infants, vaccination should not be withheld or delayed.

Immunosuppression and HIV infection

Individuals with immunosuppression and HIV infection (regardless of CD4 count) should be given pneumococcal vaccines in accordance with the recommendations above.

Studies on the clinical efficacy of PPV23 in HIV-infected adults have reported inconsistent findings, including one study from the developing world where a higher risk of pneumonia was observed in vaccinees. Observational studies in developed countries have not confirmed this finding, and most experts believe that the potential benefit of pneumococcal vaccination outweighs the risk in developed countries.

For children with HIV infection (regardless of CD4 count), clinicians may also wish to consider the joint guidance from the Paediatric European Network for Treatment of AIDS Vaccines Group and the Children’s HIV Association. Further guidance for the immunisation of HIV-infected individuals is provided by the Royal College of Paediatrics and Child Health (RCPCH; http://www.rcpch.ac.uk, the British HIV Association (BHIVA 2015; http://www.bhiva.org/vaccination-guidelines.aspx) and the Children’s HIV Association (CHIVA; http://www.chiva.org.uk/guidelines/immunisation/)

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Public Health England. Pneumococcal: the green book, chapter 25. January 2018.

Contains public sector information licensed under the Open Government Licence v3.0.

First included: May 2019.