ACIP recommendations for pneumococcal vaccines in children and adults with asplenia or hyposplenia49,50
| Age at first dose . | Timing of first dose PCV13 . | Total doses of PCV13 . | Interval between PCV13 doses . | Timing of first dose of PPSV23 . | Total doses of PPSV23 . | Interval between PPSV23 doses . |
|---|---|---|---|---|---|---|
| No prior PCV13 or PPSV23 | ||||||
| 8 wk | — | 4 doses | 2-mo, 2-mo, 6-mo intervals | — | — | — |
| 6-18 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| 19-64 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| ≥65 y* | — | 1 dose | — | >8 wk after PCV13 dose | 1 dose | — |
| Any PCV13; no prior PPSV23 | ||||||
| 2-5 y + <3 prior PCV13 doses | ≥8 wk after prior PCV13 dose | 2 doses | 8-wk interval | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 2-5 y + 3 prior PCV13 doses | ≥8 wk after prior PCV13 dose | 1 dose | — | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 6-18 y | — | — | — | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 19-64 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| ≥65 y* | — | 1 dose | — | >8 wk after PCV13 dose | 1 dose | — |
| Any PPSV23; no prior PCV13 | ||||||
| 6-18 y | ≥8 wk after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
| 19-64 y | ≥1 y after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
| ≥65 y* | ≥1 y after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
| Age at first dose . | Timing of first dose PCV13 . | Total doses of PCV13 . | Interval between PCV13 doses . | Timing of first dose of PPSV23 . | Total doses of PPSV23 . | Interval between PPSV23 doses . |
|---|---|---|---|---|---|---|
| No prior PCV13 or PPSV23 | ||||||
| 8 wk | — | 4 doses | 2-mo, 2-mo, 6-mo intervals | — | — | — |
| 6-18 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| 19-64 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| ≥65 y* | — | 1 dose | — | >8 wk after PCV13 dose | 1 dose | — |
| Any PCV13; no prior PPSV23 | ||||||
| 2-5 y + <3 prior PCV13 doses | ≥8 wk after prior PCV13 dose | 2 doses | 8-wk interval | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 2-5 y + 3 prior PCV13 doses | ≥8 wk after prior PCV13 dose | 1 dose | — | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 6-18 y | — | — | — | >8 wk after prior PCV13 dose | 2 doses | 5 y |
| 19-64 y | — | 1 dose | — | >8 wk after PCV13 dose | 2 doses | 5 y |
| ≥65 y* | — | 1 dose | — | >8 wk after PCV13 dose | 1 dose | — |
| Any PPSV23; no prior PCV13 | ||||||
| 6-18 y | ≥8 wk after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
| 19-64 y | ≥1 y after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
| ≥65 y* | ≥1 y after prior PPSV23 dose | 1 dose | — | >8 wk after PCV13 dose | 1 dose | 5 y |
For adults aged ≥65 y, routine pneumococcal vaccination is recommended. For patients with asplenia or hyposplenia, consider PCV13 before PPSV23 administration. Only 1 dose of PPSV23 is recommended for adults aged 65 y with immunocompromising conditions.