Pneumococcal vaccination
- pneumococcal immunisation protects against invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae, an encapsulated gram-positive organism (1)
- available vaccines are inactivated, non-live, and contain no thiomersal, making them incapable of causing pneumococcal disease
- UK guidance shifted from PPV23 to higher-valency conjugate vaccines (PCV20) for adult and at-risk programmes (1)
Vaccine Types and Formulations
- pneumococcal polysaccharide vaccine (PPV23): contains purified capsular polysaccharide from 23 serotypes; produces a good antibody response by week 3 in healthy adults but is ineffective in children under 2 years
- national programme update: PPV23 is no longer available to order centrally, with existing local stocks being phased out in favour of PCV20
- pneumococcal conjugate vaccines (PCVs): capsular polysaccharides conjugated to protein carriers to enhance immunogenicity, particularly in young children
- PCV13 (Prevenar 13®): covers 13 serotypes; used in routine infant immunisation
- PCV20 (Prevenar 20®): covers 20 serotypes; used for adult routine (age 65+) and clinical risk group programmes
- other licensed PCVs: PCV15 (Vaxneuvance®) and PCV21 (Capvaxive®) are licensed in the UK but not currently included in the national immunisation schedule
Indications and Clinical Risk Groups
- infants: routine childhood immunisation programme
- adults aged 65 years and over: universal offer of a single dose of PCV20 (or remaining PPV23 stocks) (1)
- clinical risk groups: children and adults with underlying high-risk conditions
- opportunistic identification: primary care staff should identify eligible patients during routine consultations, annual reviews, influenza clinics, or post-hospital discharge
Clinical risk groups who should receive the pneumococcal immunisation
Clinical risk group | Examples (decision based on clinical judgement) |
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 (chronic respiratory disease refers to chronic lower respiratory tract 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 neurological 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 |
Chronic heart disease | 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 | 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 patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, asplenia or splenic dysfunction, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement deficiency) Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day. |
Individuals with cochlear implants | It is important that immunisation does not delay the cochlear implantation |
Individuals with cerebrospinal fluid leaks | includes leakage of cerebrospinal fluid such as following trauma or major skull surgery. Conditions related to CSF leaks include all CSF shunts. |
Occupational risk | is an association between exposure to metal fume and pneumonia and infectious pneumonia, particularly lobar pneumonia and between welding and invasive pneumococcal disease. PPV23 (single 0.5ml dose in those who have not received PPV previously) should be considered for those at risk of frequent or continuous occupational exposure to metal fume (e.g. welders) taking into account the exposure control measures in place |
Childhood Schedule
- primary dose: single priming dose of 0.5 mL PCV13 administered at 16 weeks of age
- booster dose: single booster dose of 0.5 mL PCV13 administered at 1 year of age (on or after the first birthday) (1)
Adult and Clinical Risk Group Schedule
- routine age 65+ & clinical risk groups (>=2 years): single dose of 0.5 mL PCV20
- severe immunocompromise (>=2 years): two doses of PCV20 administered at least 4 weeks apart
- 5-year re-immunisation policy: periodic PCV20 boosters every 5 years are restricted to individuals with asplenia, splenic dysfunction (including sickle cell disease), or chronic kidney disease (1)
Clinical Practice Considerations
- check up-to-date details in official national guidance and individual Summary of Product Characteristics (SPC) before prescribing or administering pneumococcal vaccines
Reference:
- UK Health Security Agency (UKHSA). Pneumococcal: guidance and immunisation schedule. UKHSA Guidance. Updated 16 October 2026.
Related pages
- Unwanted effects
- At-risk groups (clinical risk groups) to be vaccinated
- Revaccination of pneumococcal vaccine
- Immunisation
- Prophylaxis in asplenic patients
- Efficacy of pneumococcal vaccination
- Pneumococcus
- Vaccination for immunising individuals with asplenia, splenic dysfunction or complement disorders
- Splenectomy and pneumococcal vaccination
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