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Pneumococcal 23-valent polysaccharide vaccine

Updated 2 Feb 2023 | Pneumococcal vaccine


Vaccine containing polysaccharide from 23 capsular types of pneumococcus.

Drugs List

  • pneumococcal 23-valent polysaccharide vaccine pre-filled syringe
  • pneumococcal 23-valent polysaccharide vaccine vial
  • PNEUMOVAX 23 vaccine pre-filled syringe
  • Therapeutic Indications


    Vaccination against pneumococcal diseases

    Active immunisation against invasive disease (including bacteraemia, sepsis, meningitis, bacteraemic pneumonia and acute otitis media ) caused by Streptococcus pneumoniae serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F.

    Vaccination should be based on official recommendations and the variability of serotype epidemiology in different geographical areas. The impact of invasive disease at different age groups should be considered.

    Individuals at an increased risk from pneumococcal infection:
    Patients aged 65 years and over
    Asplenia or splenic dysfunction
    Including homozygous sickle cell disease and coeliac disease which could lead to splenic dysfunction.
    Chronic respiratory disease
    Including chronic obstructive pulmonary disease, chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia, children with respiratory conditions caused by aspiration, or neurological disease (e.g. cerebral palsy) with risk of aspiration, asthma that requires the use of systemic steroids at a dose sufficient to act as a significant immunosuppressant.
    Chronic heart disease
    Including those requiring medication/follow up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure.
    Chronic renal disease
    Including nephrotic syndrome, chronic kidney disease at stage 4 and 5, those on kidney dialysis, and renal transplantation.
    Chronic hepatic disease
    Including cirrhosis, biliary atresia, and chronic hepatitis.
    Diabetes requiring insulin or oral hypoglycaemic drugs. Not including diabetes that is diet controlled.
    Due to disease or treatment, including asplenia or splenic dysfunction, bone marrow transplant, multiple myeloma or genetic disorder affecting the immune system, HIV infection at all stages and patients undergoing immunosuppressive chemotherapy leading to immunosuppression. Individuals on or likely to be on systemic steroids for more than one month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg/kg or greater per day.
    Individuals with cochlear implants
    Immunisation should not delay cochlear implantation.
    Individuals with cerebrospinal fluid leaks
    Includes leakage following trauma or major skull surgery. Conditions related to CSF leaks include all CSF shunts.
    At occupational risk

    For comprehensive information or advice on this product or the immunisation programme in the UK, the following website should be accessed.



    Primary vaccination
    One single dose of 0.5ml.

    One single dose of 0.5ml.

    The need and timing of revaccination should be based on official recommendations. There should be an interval of at least 3 years between doses to reduce the risk of adverse reactions. The rates of local, and in persons aged 65 years and over, some systemic reactions have been shown to be higher after revaccination than after primary vaccination when 3 to 5 years have elapsed between doses.

    Revaccination may be considered for persons at increased risk of serious pneumococcal infections who received the primary dose more than 5 years earlier, or for those with a rapid decline in pneumococcal antibody levels such as those with no spleen or splenic dysfunction. The manufacturer of the vaccine advises that revaccination should be considered after 3 years in patients at a high risk (e.g. asplenic) of developing fatal pneumococcal infections.

    There is limited clinical data available regarding the administration of more than two doses of pneumococcal polysaccharide vaccine. Healthy patients should not receive routine revaccination.


    Children aged 10 to 18 years
    Primary vaccination
    One single dose of 0.5ml.

    One single dose of 0.5ml.

    The need and timing of revaccination should be based on official recommendations and according to the information provided in the adult dose section for revaccination.

    Children aged 2 to 10 years
    Primary vaccination
    One single dose of 0.5ml.

    One single dose of 0.5ml.

    The need and timing of revaccination should be based on official recommendations. There should be an interval of at least 3 years between doses to reduce the risk of adverse reactions. Revaccination can be considered after 3 years in patients at a high risk of pneumococcal infection (e.g. patients with nephrotic syndrome, asplenia, sickle cell disease).

    Additional Dosage Information

    Pneumococcal vaccine should be administered preferably four to six weeks before an elective splenectomy or the initiation of chemotherapy, or radiotherapy. Where it is not possible, it can be administered up to two weeks before treatment. If it is not possible to vaccinate beforehand, splenectomy, or the initiation of chemotherapy or radiotherapy should not be delayed.

    If it is not practical to vaccinate at least 2 weeks before splenectomy, the vaccine should be given at least 2 weeks after the splenectomy. There may be a reduced immune response in patients after they have completed chemotherapy/radiotherapy. The vaccine should not be administered for at least 3 months following completion of such therapy. For patients who have received prolonged or intensive therapy, longer delay before vaccination may be appropriate.


    By intramuscular or subcutaneous injection only.


    Acute infection
    Children under 2 years
    Severe febrile conditions

    Precautions and Warnings

    Immunodeficiency syndromes

    Postpone immunisation if there is active or suspected infection
    Impaired response possible in immunocompromised patients
    Prophylactic antibiotic therapy should continue after immunisation
    Vaccine may not be effective in 100% of patients
    Delay treatment if acute febrile illness
    Do not mix with other vaccines in the same syringe
    Have adrenaline injection ready for use in case of anaphylaxis
    Inject other vaccines at different sites
    Resuscitation facilities must be immediately available
    Severe, sudden fever may require early antimicrobial use - advise patients
    Follow national immunisation guidelines

    Vaccination of patients with multiple myeloma, Hodgkin's and non-Hodgkin's lymphoma, especially during treatment, and in chronic alcoholics, may be relatively ineffective.

    Advise patients at increased risk of severe pneumococcal infection (e.g. asplenic, immunocompromised etc.) to contact a physician immediately if sudden severe febrile illness occurs as they may require early antimicrobial treatment.

    Patients with idiopathic thrombocytopenic purpura may develop thrombocytopenia following vaccination.

    Patients with haematological disorders may develop haemolytic anaemia following vaccination.

    There is limited clinical data available regarding the administration of more than two doses. Healthy adults and children should not receive routine revaccination.

    Pneumococcal polysaccharide vaccine may not protect against infection resulting from basilar skull fracture or from external communication with cerebrospinal fluid.

    Individuals with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis is confirmed.

    Pregnancy and Lactation


    Use pneumococcal vaccine with caution during pregnancy.

    The risk to foetus from pneumococcal polysaccharide vaccine during first trimester is unknown (Briggs, 2015).

    There have been no reports of adverse consequences in newborns whose mothers were inadvertently vaccinated during pregnancy. Pneumococcal-containing vaccines may be given to pregnant women when the need for protection is clearly necessary and required without delay.

    Schaefer (2015) concludes that vaccination does not seem to be harmful for the foetus, and does not require any intervention.


    Use pneumococcal vaccine with caution during breastfeeding.

    The manufacturer states that caution should be exercised when pneumococcal vaccine is administered during breastfeeding and it is unknown whether the vaccine is excreted in breast milk.

    Lactmed (2018) states that immunisation of the mother during the 3rd trimester of pregnancy markedly increases the amount of pneumococcal antibodies in breast milk.

    Side Effects

    Anaphylactoid reaction
    Angioneurotic oedema
    Cellulitis (injection site)
    Decreased limb mobility
    Erythema at injection site
    Febrile convulsions
    Guillain-Barre syndrome
    Haemolytic anaemia
    Heat and redness (injection site)
    Induration (injection site)
    Injection site reactions
    Pain / soreness (injection site)
    Peripheral oedema
    Raised C-reactive protein
    Serum sickness
    Swelling (injection site)


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( )

    Further Information

    Last Full Review Date: January 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Immunisation Against Infectious Disease. The Green Book.
    Available at:
    Last accessed: 09 January 2019.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Pneumococcal vaccines Last revised: 31 October 2018
    Last accessed: 09 January 2019

    NICE Evidence Services Available at: Last accessed: 09 January 2019.

    Summary of Product Characteristics: Pneumococcal Polysaccharide Vaccine. Merck Sharp and Dohme Limited. Revised April 2018.

    Summary of Product Characteristics: Pneumovax 23 solution for injection in pre-filled syringe. Merck Sharp and Dohme Limited. Revised August 2018.

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