People aged >12 months with risk conditions are recommended to receive pneumococcal conjugate vaccine and 23vPPV

All children and adults with newly identified risk conditions (see List. Risk conditions for pneumococcal disease) are recommended to receive:

• 1 dose of a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV [only people aged ≥18 years are eligible for 15vPCV or 20vPCV]) at diagnosis (at least 2 months after any previous doses of 13vPCV or 15vPCV), and
• 1 dose of 23vPPV 12 months after a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) (2–12 months later is acceptable), and
• a 2nd dose of 23vPPV at least 5 years after the 1st dose of 23vPPV

Aboriginal and Torres Strait Islander children <5 years of age with risk conditions who live in the Northern Territory, Queensland, South Australia and Western Australia already receive these doses as part of their routine schedule. 

Children aged <5 years with risk conditions who have not received all the recommended 13vPCV doses should receive doses of 13vPCV according to the catch-up schedule. See Table. Catch-up schedule for 13vPCV for Aboriginal and Torres Strait Islander children living in NT, Qld, SA or WA ONLY, and all children with any risk condition(s) for pneumococcal disease, aged <5 years. 

All children and adults with existing risk conditions are recommended to receive a pneumococcal conjugate vaccine if they have not previously received this recommended dose. 13vPCV, 15vPCV and 20vPCV are available to people aged ≥18 years and only 13vPCV is available to people aged <18 years. This dose of conjugate vaccine should be followed by 2 doses of 23vPPV. 

People who have previously received doses of 23vPPV are recommended to receive an age appropriate pneumococcal conjugate vaccine 12 months after their last 23vPPV dose. If they have already received at least 2 doses of 23vPPV, no further 23vPPV doses are recommended. 

There is no preference for either 13vPCV, 15vPCV or 20vPCV in people aged ≥18 years. It should be noted that 15vPCV may provide anticipated protection against two additional serotypes compared to 13vPCV, however this improvement is diminished after receiving 23vPPV. 20vPCV may provide protection against seven additional serotypes, when compared to 13vPCV, but it is uncertain if this improvement is maintained after receiving 23vPPV. People aged <18 years are not eligible to receive 15vPCV or 20vPCV.

Aboriginal and Torres Strait Islander adults aged ≥50 years already receive these doses, and they do not need to be repeated. The exception is people who have received a haematopoietic stem cell transplant — these people are recommended to receive 3 doses of 13vPCV or 15vPCV after transplantation. See Table. Recommendations for revaccination after haematopoietic stem cell transplant in children and adults.

A minimum interval of 2 months between the last dose of an age appropriate pneumococcal conjugate vaccine and 23vPPV is recommended. This is based on a small number of studies in children of different ages with underlying conditions. These studies have shown that 23vPPV elicits a good immune response when given approximately 2 months after a 7vPCV dose^5-8 and this is considered also applicable to other pneumococcal conjugate vaccines. A study in adults infected with HIV also found that 23vPPV elicits a good immune response when given 2 months after a 15vPCV dose.⁹