Skip to main content
hpa logo
Topics A-Z:
Search the site:
Home Topics Infectious Diseases Infections A-Z Pneumococcal Disease Guidelines ›  Pneumococcal Vaccination Recommendations

Pneumococcal Vaccination Recommendations

Who should be vaccinated?

Older Adults - All adults aged 65 or over are recommended to have the Pneumococcal Polysaccharide Vaccine (PPV)

In 2003 the Chief Medical Officer (CMO) outlined a new pneumococcal immunisation programme for older adults to be phased in over 3 years (CMO's letter). In August 2003, the first phase was implemented and the PPV was recommended to those aged 80 and over. In April 2004, phase 2 began. Anyone age 75 or over were offered the PPV. This included those aged 80 or more who did not receive their vaccine in the first phase. In April 2005 the policy was fully implemented and all those aged 65 and over were recommended to have the Pneumococcal polysaccharide vaccine.

From 4 September 2006

All those aged two months to under two years of age (Outline of changes ot the Routine Childhood Immunisation effective from 4 September 2006)

On 12 July 2006, the CMO's letter outlined changes to the Childhood Immunisation Programme would be effective as of 4 September 2006.These changes include universal infant immunisation with PCV. From September onwards, children should be offered the PCV at two months, four months and 13 months.
Full details of the new  Routine Childhood Immunsation Programme can be found in the Vaccination  section of this website.

Children who are aged over 2 months at the start of the programme

From Septemer 2006 onwards, all children aged over 2 months and under 2 years of age will be offered PCV as part of the catch-up campaign.

Children born between 5/9/04 and 3/8/05 (i.e. aged over 13 months of age and under 2 years at the start of the programme) should be offered one dose of PCV.

Children born between 4/8/05 and 3/2/06 (i.e aged 8 months to 13 months of age at the start of the programme) should be offered one dose of PCV at their routine 13 month visit.

Children born between 4/2/06 and 3/7/06 (i.e. aged over two months and under 8 months of age at the start of the programme) should be offered two doses of PCV separated by a period of two months. These children should also be offered a further dose at 13 months of age.

At-risk children presenting late for immunisation

At-risk children who present late for vaccination should be offered 2 doses of PCV* before the age of 12 months, and a further dose at 13 months of age.  They should also be offered a single dose of PPV when they are two years of age or older.

At-risk children aged over 12 months and under 5 years of age should be offered a single dose of PCV.  Please note that children in this age group who have asplenia or splenic dysfunction, or who are immunocompromised, require a second dose of PCV because this group may have a sub-optimal immunological response to the first dose of vaccine.  This should be given 2 months after the first dose.  All at risk children should also be offered a single dose of PPV, if not previously given, when they are two years of age or older (and at least 2 months after the final dose of PCV).

At-risk children presenting for first pneumoccal immunisation aged 5 years and over should be offered a single dose of PPV. 

*one month apart if necessary to ensure 2 doses are given before a dose at 13 months.

For more information, please see:Department of Health Press release, dated 8th February 2006

For current recommendations please see the revised chapter on Pneumococcal disease in the Green Book [external link].

Children and adults at risk

Children at an increased risk of pneumococcal infection

Some groups of children are at increased risk from pneumococcal infection (see the table below).

From 4 September 2006, all children, should be offered PCV vaccine according to the schedule for the routine immunisation programme (i.e. at 2, 4 and 13 months of age).  In addition, all at-risk children should be offered a single dose of pneumococcal polysaccharide vaccine (PPV) when they are two years of age or over.

Please see the revised chapter on Pneumococcal disease in the Green Book  [external link] for current recommendations.

Adults under 65 with one of the following risk conditions are recommended for vaccination.

Since 1992 PPV has been recommended for people under 65 with medical conditions for whom pneumococcal infection was likely to be more common or more serious. The clinical risk groups who should receive pneumococcal immunisation are listed below.

Clinical Risk category
Examples (decision based on clinical judgement)
Asplenia or dysfunction of the spleen

This includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.

Chronic Respiratory Disease*

This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).  Children with respiratory conditions caused by aspiration, or a neuromuscular disease (e.g. cerebral palsy) with a risk of aspiration.  Asthma is not an indication, unless continuous or frequently repeated use of systemic steroids (as defined in Immunosuppression below) is needed.

Chronic heart disease

This includes those requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure.

Chronic renal disease

This includes nephrotic syndrome, chronic renal failure, renal transplantation.

Chronic liver disease    This includes cirrhosis, biliary atresia, chronic hepatitis
Diabetes (requiring insulin or oral hypoglycaemic drugs)

This includes type I diabetes requiring insulin or type 2 diabetes requiring oral hypoglycaemic drugs.  It does not include diabetes that is diet controlled.


Due to disease or treatment, including asplenia or splenic dysfunction and HIV infection at all stages. Patients undergoing chemotherapy leading to immunosuppression. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone 20mg or more per day (any age), or for children under 20kg, a dose of ?1mg/kg/day.

Some immunocompromised patients may have a suboptimal immunological response to the vaccine.

Individuals with cochlear implants

It is important that immunisation does not delay the cochlear implantation.  Where possible, pneumococcal vaccination should be completed at least 2 weeks prior to surgery to allow a protective immune response to develop.  In some cases it will not be possible to complete the course prior to surgery.  In this instance, the course should be started at any time prior to or following surgery and completed according to the immunisation schedule

Individuals with cerebrospinal fluid leaks

This includes leakage of cerebrospinal fluid such as following trauma or major skull surgery.


Please also see the revised chapter on Pneumococcal disease in the Green Book [external link] for details on current recommendations.

Last reviewed: 18 February 2014