Contents

15 Pneumococcal disease

15.5 Recommended immunisation schedule

See Table 15.5 for an overall summary of pneumococcal vaccination schedules.

15.5.1 Healthy children

A primary course of PCV13 vaccine is given at ages 6 weeks, 3 months and 5 months, followed by a booster dose at age 15 months. Children who have started their immunisation course on PCV10 can complete it with PCV13.

Where a previously unimmunised healthy child presents late for pneumococcal vaccination, the age-appropriate catch-up schedules in Appendix 2 should be followed.

15.5.2 Children at high or increased risk of pneumococcal disease Top

Children at high or increased risk of pneumococcal disease are shown in Table 15.3 below. PCV13 and 23PPV are recommended for these children. See Table 15.5 for vaccine schedules. 

PCV13

As with healthy children, a primary course of PCV13 vaccine is given to children at high or increased risk at ages 6 weeks, 3 months and 5 months, followed by a booster dose at age 15 months. Children aged under 5 years who have started their immunisation course with PCV10 can complete it with PCV13. 

Where a previously unimmunised high- or increased-risk child aged under 5 years presents late for pneumococcal vaccination, the age-appropriate catch-up schedules in Table 15.5 below should be followed.

If a high-risk child aged over 17 months to under 18 years has not received PCV13, give one dose. This dose of PCV13 should still be given even if the child completed vaccination with another PCV vaccine.

23PPV

23PPV is funded for children at high risk of pneumococcal disease and is recommended, but not funded, for other children at increased risk. One dose of 23PPV is given for this group from age 2 years, and at least eight weeks after the last dose of PCV13. If the risk persists, revaccination once with 23PPV is recommended (and funded for high-risk children) five years after the first 23PPV. (See Table 15.5).

Table 15.3: Children aged under 18 years at high and increased risk of pneumococcal disease

Note: Funded conditions are in the shaded rows. See the Pharmaceutical Schedule (www.pharmac.govt.nz) for the number of funded doses and any changes to the funding decisions. See also section 4.3 for more information about immune-deficient individuals, including additional vaccine recommendations and schedule tables for certain conditions.

Children at high risk of pneumococcal disease
HIV infection
Post-haematopoietic stem cell transplant (HSCT) or chemotherapy
Pre- or post-splenectomy or with functional asplenia
Pre- or post-solid organ transplant
Renal dialysis
Complement deficiency (acquired or inherited)
Cochlear implants
Primary immune deficiency
Children at increased risk of pneumococcal disease
Renal failure and/or nephrotic syndrome
Intracranial shunts
Cerebrospinal fluid leaks
Receiving corticosteroid therapy for more than two weeks, and who are on an equivalent daily dosage of prednisone of 2 mg/kg per day or greater, or children who weigh more than 10 kg on a total daily dosage of 20 mg or greater
Chronic pulmonary disease (including asthma treated with high-dose corticosteroid therapy)
Preterm infants with chronic lung disease
Cardiac disease, with cyanosis or failure
Diabetes
Down syndrome
Immune-competent children at increased risk of pneumococcal disease or its complications because of chronic illness (eg, chronic cardiac, renal or liver disease)
Immune-compromised children at increased risk of pneumococcal disease (eg, those with multiple myeloma, lymphoma and Hodgkin’s disease)
Children who have had one episode of invasive pneumococcal disease

15.5.3 Adults at high or increased risk of pneumococcal diseaseTop

Adults53 at high or increased risk of pneumococcal disease include those in Table 15.4 below. PCV13 and 23PPV are recommended for these adults. See Table 15.5 for vaccine schedules.

PCV13

A single dose of PCV13 is funded for adults at high risk of pneumococcal disease and is recommended, but not funded, for adults at increased risk (listed in Table 15.4 below).

23PPV

23PPV is funded for adults at high risk of pneumococcal disease and is recommended but not funded for adults at increased risk (see Table 15.4). Revaccination with polysaccharide vaccine (23PPV) is recommended and funded after five years for adults belonging to high-risk groups, who frequently exhibit a poor immune response.54 A maximum of three 23PPV doses is recommended in a lifetime. 

Table 15.4: Adults (≥18 years) at high or increased risk of pneumococcal disease

Note: Funded conditions are in the shaded rows. See the Pharmaceutical Schedule (www.pharmac.govt.nz) for the number of funded doses and any changes to the funding decisions. See also section 4.3 for more information about immune-deficient individuals, including vaccine recommendations and schedule tables for certain conditions.

Adults at high risk of pneumococcal disease
HIV infection
Post-haematopoietic stem cell transplant (HSCT) or chemotherapy
Pre- or post-splenectomy, or with functional asplenia
Pre- or post-solid organ transplant
Renal dialysis
Complement deficiency (acquired or inherited)
Cochlear implants
Primary immune deficiency
Adults at increased risk of pneumococcal disease
Immune-competent individuals at increased risk of pneumococcal disease or its complications because of chronic illness (eg, chronic cardiac, renal, liver or pulmonary disease, diabetes or alcoholism)
Cerebrospinal fluid leak
Immune-compromised individuals at increased risk of pneumococcal disease (eg, those with nephrotic syndrome, multiple myeloma, lymphoma and Hodgkin’s disease)
Individuals who have had one episode of invasive pneumococcal disease
Individuals aged 65 years and older

15.5.4 (Re-)vaccinationTop

Pneumococcal conjugate vaccine (Prevenar 13) is funded for (re‑)vaccination of children and adults:

(See also sections 4.2 and 4.3).

15.5.5 Summary of pneumococcal vaccine schedulesTop

Table 15.5: Summary of pneumococcal vaccine schedules

Note: See the Pharmaceutical Schedule (www.pharmac.govt.nz) for the number of funded doses and any changes to the funding decisions. See also section 4.3 for more information about immune-deficient individuals, including vaccine recommendations and schedule tables for certain conditions.

Age Vaccine Schedule
Healthy children 
<5 years
PCV13 PCV13,a at age 6 weeks, 3, 5 and 15 months, or age-appropriate catch-up schedule (see Appendix 2).
Children <5 years at high or increased risk​
 
PCV13 PCV13,a,b at age 6 weeks, 3, 5 and 15 months (usual childhood Schedule) or age-appropriate catch-up schedule, as follows:
  • if commencing immunisation at ages 7–11 months, give 2 doses of PCV13 at least 4 weeks apart, followed by a booster dose at age 15 months
  • if commencing immunisation at ≥12 months of age, give 2 doses of PCV13,b 8 weeks apart.
  • for children aged >17 months who have completed the primary course with PCV10 but not received PCV13, give 1 dose of PCV13b,c,d
23PPV Following the completion of the PCV course, give 1 dose of 23PPVe at age ≥2 years. There must be at least 8 weeks between the last PCV dose and the 23PPV dose.

If risk persists, revaccinate once with 23PPV,e 5 years after the 1st 23PPV.
​​Children 5 to <18 years at high or increased risk
 
PCV13 For children who have not previously received PCV13, give 1 dose.b,c,d
23PPV 1 dose of 23PPVe at least 8 weeks after the PCV13 dose.

Revaccinate once with 23PPV,e 5 years after the 1st 23PPV.
Adults 
≥18 years at high or increased risk
PCV13 1 dose of PCV13.b,f
23PPV ​Give a maximum of 3 doses of 23PPVe in a lifetime, a minimum of 5 years apart. The 1st 23PPV dose is given at least 8 weeks after PCV13; the 2nd a minimum of 5 years later; the 3rd dose at age ≥65 years.
Adults ≥65 years with no other risk factors PCV13 1 dose of PCV13.b
23PPV ​1 dose of 23PPV, given at least 8 weeks after PCV13.

Key: PCV13 = 13-valent pneumococcal conjugate vaccine (Prevenar 13); 23PPV = 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23).

Notes
 
a Children who started their immunisation course with PCV10 may complete it with PCV13.
b If 23PPV has already been given (prior to any doses of PCV13), wait at least 1 year before administering PCV13.
c There are no safety concerns, regardless of the interval between the last dose of PCV10 and the first dose of PCV13.
d This dose of PCV13 is only funded for high-risk children; it is not funded for children at increased risk. 
e 23PPV is only funded for children and adults at high risk; it is not funded for children and adults at increased risk.
f This dose of PCV13 is only funded for high-risk adults; it is not funded for adults at increased risk.