The ACIP recommends PCV13 for all children 2 through 59 months of age and for children 60 through 71 months of age who have underlying medical conditions that increase their risk of pneumococcal disease or complications.

　　1. Infants and children who have not previously received PCV7 or PCV13

　　o The ACIP recommendation for use of PCV13 and the immunization schedules for infants and toddlers 2 through 59 months of age who have not received any prior PCV7 or PCV13 doses are the same as those previously published for PCV7 with PCV13 replacing PCV7 for all doses (MMWR 2000; 49 (RR-9).

　　Infants 2 through 6 months of age

　　o PCV13 is recommended as a 4-dose series at 2, 4, 6, and 12 through 15 months. Infants receiving their first dose at age <6 months should receive 3 doses of PCV13 at intervals of approximately 8 weeks (the minimum interval is 4 weeks). Minimum age for administration of first dose is 6 weeks. The fourth dose is recommended at age 12 through 15 months and should be given at least 8 weeks after the third dose (Table 1).

　　Unvaccinated children 7 months of age and older

　　Infants 7 through 11 months of age

　　 Three doses are recommended. The first 2 doses should be given with an interval of at least 4 weeks between doses. The third dose should be give at age 12 through 15 months, at least 8 weeks after the second PCV13 dose (Table 1).

　　Children 12 through 23 months of age

　　 Two doses are recommended, with an interval of at least 8 weeks between doses (Table 1).

　　Children 24 months of age and older

　　 Unvaccinated healthy children 24 through 59 months of age should receive a single dose of PCV13. Unvaccinated children 24 through 71 months of age with underlying medical conditions should receive 2 doses of PCV13 with an interval of at least 8 weeks between doses (Table 2).

　　2. Children incompletely vaccinated with PCV7 or PCV13

　　Children <24 months of age

　　o Infants and children <24 months of age who have received one or more doses of PCV7 should complete the immunization series with PCV13 (Table 1).

　　Children >24 months of age

　　o A single dose of PCV13 is recommended for all healthy children 24 through 59 months of age with any incomplete PCV schedule (PCV7 or PCV13) (Table 2).

　　o For children 24 through 71 months of age with underlying medical conditions who have received any incomplete schedule of <3 doses of PCV (PCV7 or PCV13), 2 doses of PCV13 are recommended. For children with underlying medical conditions who have received 3 doses of PCV (PCV7 or PCV13), a single dose of PCV13 is recommended through 71 months of age (Table 2).

　　o The minimum interval between doses is 8 weeks.

　　3. Children completely vaccinated with PCV7

　　o A single supplemental dose of PCV13 is recommended for all children 14 through 59 months of age who have received 4 doses of PCV7 or other age-appropriate, complete PCV7 schedule (fully vaccinated with PCV7) (Tables 1 and 2).

　　o For children who have underlying medical conditions, a single supplemental PCV13 dose is recommended through 71 months of age (Table 2). This includes children who have previously received the 23-valent pneumococcal polysaccharide vaccine (PPSV23).

　　o PCV13 should be given at least 8 weeks after the last dose of PCV7 or PPSV23.

　　4. Children 6 through 18 years of age with high risk conditions

　　o A single dose of PCV13 may be adminstered for children 6 through 18 years of age who are at increased risk for invasive pneumococcal disease because of sickle cell disease, HIV-infection or other immunocompromising condition, cochlear implant or cerebrospinal fluid leaks, regardless of whether they have previously received PCV7 or PPSV23.

　　5. Use of PPSV23 among children 2 through 18 years of age who are at increased risk for invasive pneumococcal disease

　　o In addition to receiving PCV13, children with underlying medical conditions should receive PPSV23 at age 2 years or as soon as possible after the diagnosis of chronic illness is made in children >2 years.

　　o Doses of PCV13 should be completed before PPSV23 is given.

　　o The minimum interval is at least 8 weeks after the last dose of PCV13.

　　o However, children who have previously received PPSV23 should also receive the recommended PCV13 doses.

　　o A second dose of PPSV23 is recommended 5 years after the first dose of PPSV23 for children who have sickle cell disease, or functional or anatomic asplenia, HIV-infection, or other immunocompromising condition

　　o No more than two PPSV23 doses are recommended.

　　Table 1. Recommended schedules for administering doses of PCV13 to children <24 months of age by PCV vaccination history and age

　　Footnotes, Table 1:

　　1) Minimum interval between doses is 8 weeks except for children vaccinated at age <1 year, for whom minimum interval between doses is 4 weeks.

　　2) No additional PCV13 doses are indicated for children 12 through 23 months of age who have received 2 or 3 doses of PCV7 before age 12 months and at least 1 dose of PCV13 at age 12 months or older.

　　* For children who have underlying medical conditions, a supplemental PCV13 dose is recommended through 71 months of age. For list of conditions, see MMWR 2010;59:9.

　　Table 2. Recommended schedules for administering doses of PCV13 to children >24 months of age by PCV vaccination history and age

　　Footnotes, Table 2:

　　1) Minimum interval between doses is 8 weeks.

　　* For children who have underlying medical conditions, a supplemental PCV13 dose is recommended through 71 months of age. For list of conditions, see MMWR 2010;59:9.

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