There are 2 vaccines that can be used to protect patients at risk for severe infection due to age, concurrent disease or an immunocompromised state. The need for immunoprotection is increasing as antibiotic resistant strains of Streptococcus pneumoniae become more prevalent.



(1) unconjugated 23-valent polysaccharide

(2) conjugated heptavalent


Indications for Primary Vaccination

Age of Patient

Who Should Be Vaccinated


< 24 months


conjugated heptavalent

2 – 64 years of age

those with one or more risk factors (see below)

unconjugated 23-valent polysaccharide

>= 65 years of age


unconjugated 23-valent polysaccharide


Risk factors:

(1) Alaskan or American Indian 50 to 64 years of age living in an area with increased risk of invasive pneumococcal disease

(2) alcoholic

(3) asplenia (anatomic or functional) or splenic dysfunction

(4) chronic cardiovascular disease (including congestive heart failure, cardiomyopathy, etc)

(5) chronic liver disease or cirrhosis

(6) chronic lung disease (including asthma and chronic obstructive pulmonary disease)

(7) people who smoke cigarettes

(8) chronic renal failure

(9) corticosteroid therapy

(10) diabetes mellitus

(11) group child care

(12) HIV-positive (vaccinate as close to seroconversion as possible)

(13) immunosuppression

(14) leukemia or lymphoma

(15) long-term care facility or nursing home resident

(16) metastatic carcinoma

(17) multiple myeloma

(18) nephrotic syndrome

(19) sickle cell disease

(20) transplant recipient

(21) cochlear implant

(22) CSF leak



(1) Avoid vaccination during chemotherapy or radiation therapy.

(2) Primary vaccination with the unconjugated 23-valent polysaccharide vaccine is not recommended for children < 2 years of age at this time due to the poor antibody response. The conjugated heptavalent vaccine should be used instead.


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