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Pneumococcal vaccine (PPV23) Pregnancy: Animal studies are insufficient with respect to effects on reproductive toxicity. The vaccine should not be used during pregnancy unless clearly necessary (the potential benefit must justify any potential risk to the foetus). Breast-feeding: it is unknown whether this vaccine is excreted in human milk - caution should be exercised when it is administered to a nursing mother. Fertility: the vaccine has not been evaluated in fertility studies.

Pneumococcal polysaccharide vaccine

Brand names: Pneumovax 23

Pneumococcal polysaccharide vaccine (PPV23) is an inactivated vaccine containing capsular polysaccharides from multiple Streptococcus pneumoniae serotypes, used to protect older adults and clinical risk groups against invasive pneumococcal disease.

Adult dose

Dose: Primary vaccination against pneumococcal disease (adults and children of 2 years of age or older): one single dose of 0.5 millilitre by intramuscular or subcutaneous injection. Revaccination, where indicated by official recommendations: one single dose of 0.5 millilitre by intramuscular or subcutaneous injection.
Route: Intramuscular (IM) or subcutaneous (SC) injection - 'A dose of 0.5 mL from a single-dose of Pneumococcal polysaccharide vaccine is to be injected intramuscularly (IM) or subcutaneously (SC).' The vaccine should never be injected intravascularly, and precautions should be taken to make sure the needle does not enter a blood vessel; it should not be injected intradermally, as injection by that route is associated with increased local reactions.
Frequency: Single dose. Revaccination is not routine - the specific timing of, and need for, revaccination should be determined on the basis of available official recommendations, and revaccination at an interval of less than three years is not recommended because of an increased risk of adverse reactions.
Max: One single dose of 0.5 millilitre - this SPC states a 0.5 mL single dose for both primary vaccination and revaccination and gives no higher dose. There are very limited clinical data regarding administration of more than two doses of pneumococcal polysaccharide vaccine.
SCHEDULE AUTHORITY: 'The immunisation schedules for Pneumococcal polysaccharide vaccine should be based on official recommendations.' REVACCINATION IN ADULTS: healthy adults should not be revaccinated routinely; revaccination may be considered for persons at increased risk of serious pneumococcal infection who were given pneumococcal vaccine more than five years earlier, or for those known to have a rapid decline in pneumococcal antibody levels; for selected populations (e.g. asplenics) known to be at high risk of fatal pneumococcal infections, revaccination at three years may be considered. SPECIAL DOSING / TIMING: it is recommended that pneumococcal vaccine should preferably be given at least two weeks before elective splenectomy or the initiation of chemotherapy or other immunosuppressive treatment; vaccination during chemotherapy or radiation therapy should be avoided, and the vaccine should not be administered any sooner than three months after completion of such therapy (a longer delay may be appropriate after intensive or prolonged treatment). Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis is confirmed. Some sections of the product information we used were incomplete — check the full SPC.

Paediatric dose

Route: Intramuscular (IM) or subcutaneous (SC) injection; never intravascularly or intradermally
Frequency: Single dose from 2 years of age; revaccination only as set out below
FIXED VOLUME DOSE, NOT WEIGHT-BASED - dosePerKg is deliberately null because this SPC expresses the paediatric dose as a fixed 0.5 millilitre volume, identical to the adult dose, not as a per-kilogram figure. Do not derive a per-kg value. VERBATIM: 'Adults and children of 2 years of age or older- one single dose of 0.5 millilitre by intramuscular or subcutaneous injection.' UNDER 2 YEARS, verbatim: 'Pneumococcal polysaccharide vaccine is not recommended for use in children below 2 years of age as the safety and efficacy of the vaccine have not been established and the antibody response may be poor.' REVACCINATION IN CHILDREN: healthy children should not be revaccinated routinely; children of 10 years of age and over may be considered for revaccination according to the adult recommendation; children between the ages of 2 and 10 years should only be considered for revaccination after 3 years if they are at high risk of pneumococcal infection (e.g. those with nephrotic syndrome, asplenia or sickle cell disease). Verify all under-18 immunisation against current official immunisation recommendations and a children's formulary.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance(s) or to any of the excipients
  • Delay the use of the vaccine in any significant febrile illness, other active infection, or when a systemic reaction would pose a significant risk - except when this delay may involve even greater risk

Side effects

  • Injection site reactions - erythema, induration, pain, soreness, swelling and warmth (very common); reactions occurred within 3 days of vaccination and typically resolved by day 5
  • Fever (38.8 degrees C or below) - very common
  • Extensive swelling of the vaccinated limb - rare (cellulitis-like reactions with short onset time from vaccine administration)
  • Asthenia/fatigue, myalgia and headache - the most common systemic adverse events overall
  • Chills, fever, malaise, decreased mobility of the injected limb, injection site necrosis, peripheral oedema in the injected extremity - frequency not known
  • Haemolytic anaemia (in patients who have had other haematologic disorders), leukocytosis, lymphadenitis, lymphadenopathy, thrombocytopenia (in patients with stabilised idiopathic thrombocytopenic purpura) - frequency not known
  • Anaphylactoid reactions, angioneurotic oedema, serum sickness - frequency not known
  • Febrile convulsions, Guillain-Barre Syndrome, headache, paraesthesia, radiculoneuropathy - frequency not known
  • Nausea, vomiting, rash, urticaria, arthralgia, arthritis, myalgia, increased C-reactive protein - frequency not known
  • Note: 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 three to five years have elapsed between doses.
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • As with any vaccine, adequate treatment provisions including epinephrine (adrenaline) should be available for immediate use should an acute anaphylactic reaction occur
  • Expect a reduced antibody response in patients immunosuppressed by an underlying condition or by treatment (e.g. cancer chemotherapy or radiation therapy) - such patients may not be as well protected against pneumococcal disease as immunocompetent individuals, and vaccination with this vaccine may not result in complete protection in any recipient
  • Required prophylactic antibiotic therapy against pneumococcal infection should not be stopped after pneumococcal vaccination
  • Advise patients at especially increased risk of serious pneumococcal infection (e.g. asplenics and those who have received immunosuppressive therapy for any reason) about the possible need for early antimicrobial treatment in the event of severe, sudden febrile illness
  • The vaccine may not be effective in preventing infection resulting from basilar skull fracture or from external communication with cerebrospinal fluid
  • This list may be incomplete — check the full SPC.

Clinical monograph

How it works

It stimulates a T-cell-independent B-cell antibody response against the included capsular polysaccharides, promoting opsonisation and clearance of pneumococci, though it does not generate robust immunological memory.

Prescribing in practice

  • Because the polysaccharide response is T-cell independent, it is poorly immunogenic in young children, so a conjugate vaccine is used instead in that group per the UK immunisation schedule.
  • Routine re-vaccination is generally not recommended for immunocompetent adults; repeat dosing is reserved for defined high-risk groups as set out in current immunisation guidance.
  • Administer by intramuscular (or subcutaneous) injection, ideally given before planned splenectomy or immunosuppression where feasible.

Monitoring

No routine laboratory monitoring is required; observe briefly after administration for immediate hypersensitivity.

Counselling the patient

  • Mild soreness, redness or a low-grade fever after the injection is common and short-lived.
  • This vaccine reduces the risk of serious pneumococcal infection but does not prevent all chest infections.
  • Keep a record of the date given, as the need for any further dose depends on your individual risk.

Evidence & guidelines

PPV23 is recommended in the UK immunisation programme (Green Book) for adults aged sixty-five and over and for clinical risk groups.

Reference: UKHSA Green Book Ch.25; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways