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North Carolina Immunization Branch

Vaccine Preventable Diseases

Pneumococcal Disease

The Disease

Pneumococcal disease is an infection caused by a type of bacteria called Streptococcus pneumoniae (pneumococcus). There are different types of pneumococcal disease, such as pneumococcal pneumonia, bacteremia, meningitis, and otitis media.

The Vaccine

There are two types of pneumococcal vaccine.

  • The 13-valent pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) is currently recommended for all children under 5 years of age.
  • The 23-valent pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®) is currently recommended for adults older than 65 years of age and for persons who are 2 years and older and at high risk for disease (e.g., sickle cell disease, HIV infection, or other immunocompromising conditions). It is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma.

Who Should get Vaccinated?

Infants and children under 2 years of age:

  • PCV13 is routinely given to infants as a series of 4 doses, one dose at each of these ages: 2 months, 4 months, 6 months, and 12 through 15 months.
  • Children who miss their shots or start the series later should still get the vaccine. The number of doses recommended and the intervals between doses will depend on the child’s age when vaccination begins. Ask your healthcare provider for details.

Children 2 through 5 years of age:

  • Healthy children 24 months through 4 years of age who are unvaccinated or have not completed the PCV13 series should get one dose.
  • Children 24 months through 5 years of age with medical conditions such as those listed below should get one or two doses of PCV13 if they have not already completed the 4-dose series. Ask your healthcare provider for details.
    • sickle cell disease
    • a damaged spleen or no spleen
    • cochlear implants
    • cerebrospinal fluid (CSF) leaks
    • HIV/AIDS or other diseases that affect the immune system (such as diabetes, cancer, or liver disease)
    • chronic heart or lung disease
    • or children who take medications that affect the immune system, such as chemotherapy or steroids

Children 6 through 18 years of age:

  • A single dose of PCV13 may be given to children 6 through 18 years of age with certain medical conditions (i.e., sickle cell disease, HIV-infection, or other immunocompromising condition, cochlear implant, or cerebrospinal fluid leaks), regardless of whether they have previously received a pneumococcal vaccine. Ask your healthcare provider for details.

All adults 65 years of age and older:

  • Administer 1-time dose of PCV13-naïve adults at age 65 years, followed by a dose of PPSV23 12 months later.

Adults age 19 through 64 years of age who have any of the conditions specificed below should receive one dose of PCV 13:

  • Immunocompromising conditions (e.g., congenital or acquired immunodeficiency, HIV, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, immunosuppression by corticosteroids or chemotherapy, solid organ transplant, and multiple myeloma)
  • Functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies and congenital and acquired asplenia)
  • Cerebrospinal fluid (CSF) leak
  • Cochlear implant

PPSV23 (1-2 doses) is recommended for adults 19-64 years of age who meet any of the criteria below:

  • Cigarette smokers
  • Chronic cardiovascular disease (excluding hypertension)
  • Chronic pulmonary disease
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease
  • Candidate for or recipient of chochlear implant
  • Cerebrospinal fluid leak
  • Functional or anatomic asplenia
  • Immunocompromising conditions
  • Solid organ transplantation or bone marrow transplantation
  • Chronic renal failure or nephrotic syndrome

North Carolina Requirements

Four doses. Three doses by age seven months and a booster dose at 12 through 15 months of age. Individuals who receive the first dose of pneumococcal conjugate vaccine on or after seven months of age and before 12 months of age are required to have two doses at least four weeks apart; and a booster dose at 12 through 15 months of age. Individuals who receive the first dose on or after 12 months of age and before 24 months of age are required to have two doses at least eight weeks apart to complete the series. Individuals who receive the first dose on or after 24 months of age and before five years are required to have one dose to complete the series.

No individual who has passed his or her fifth birthday shall be required to be vaccinated against pneumococcal disease. Individuals born before July 1, 2015 are not required to receive pneumococcal conjugate vaccine.

Additional Resources



Updated: September 11, 2019