Pneumococcal Vaccination Pocket Guide

A guide to assist healthcare providers in determining who should receive a pneumococcal vaccination.

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Pneumococcal Vaccination Pocket Guide (PDF: 46KB/2 pages)

On this page:
Contraindications and precautions
Unknown history
Vaccine administration
Who gets a second dose of PPSV
Talking points with patients


Pneumococcal polysaccharide vaccine (PPSV) is indicated for persons age 65 years or older, or age 2 through 64 years with any of the following:

  • Chronic cardiovascular disease (e.g., CHF, cardiomyopathies)
  • Chronic pulmonary disease (e.g., emphysema or COPD, including asthma)
  • Cigarette smokers age 19 through 64 years
  • Chronic liver disease, including persons with long-term alcoholism
  • Diabetes mellitus
  • CSF leaks
  • Functional or anatomic asplenia (e.g., sickle cell disease or splenectomy)
  • Immunosuppressive conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin’s disease, lymphoma, multiple myeloma, or generalized malignancy)
  • Organ or bone marrow transplantation
  • Therapy with alkylating agents, antimetabolites, or systemic corticosteroids
  • Chronic renal failure or nephrotic syndrome
  • Cochlear implants

Contraindications and precautions

  • Previous anaphylactic reaction to PPSV or any of its components
  • Moderate to severe illness

Unknown history

Make a reasonable effort to obtain a vaccination history. When in doubt, vaccinate. The risks of invasive pneumococcal disease outweigh the risks of revaccination.

Vaccine administration

Administer 0.5 ml PPSV intramuscularly (IM) or subcutaneously (SC):

  • IM: 1 - 1.5” 22-25 gauge needle OR
  • SC: 5/8” 23-25 gauge needle
  • Children age 2 years or older at risk for invasive pneumococcal disease need PPSV. It should be separated by 8 weeks from a dose of PCV.

Who gets a second dose of PPSV

Algorithm for pneumococcal vaccination


A maximum of two PPSV doses in a lifetime is all that is recommended.

A second dose is indicated for persons:

  • Age 2 through 64 years with any of the following: functional or anatomic asplenia, immunosuppression, transplant, chronic renal failure, nephrotic syndrome.
  • Age 65 years or older who received the first dose prior to age 65 years.
Age of patient: Spacing between shots:

Age 2 through 9 years

3 years apart
Age 10 through 64 years At least 5 years apart
Age 65 years or older At least 5 years apart

Talking points with patients

  • Most pneumococcal deaths are in people age 65 or older.
  • Flu and its most common complication, pneumonia, are the sixth leading cause of death in Minnesota.
  • PPSV is 60-70% effective in preventing most strains of pneumonia from spreading to the blood (bacteremia) or brain (meningitis). Immunization can prevent prolonged hospitalization or death due to invasive pneumococcal disease.
  • The vaccine is important because pneumococcal disease is increasingly drug-resistant and hard to treat.
  • Medicare Part B and most health plans pay for the vaccine.
  • The vaccine is safe; the most common side effect is a sore arm lasting 24-48 hours.
  • PPSV can be given at any time during the year.
  • It’s okay to get this shot at the same time as the flu shot or any other vaccine.

Updated Monday, August 12, 2013 at 12:55PM