Pneumococcal Vaccine Schedule and Side Effects

Written by Joseph Saling, Kathryn Whitbourne
Medically Reviewed by Poonam Sachdev, MD on February 16, 2025

Pneumococcal disease can cause serious respiratory (breathing) problems for very young children and older adults. To help prevent this, there are three pneumococcal conjugate vaccines (PCVs) currently recommended in the U.S.: PCV15, PCV20, and PCV21. (An earlier vaccine, PCV13, is no longer recommended for routine use.) Conjugate vaccines link pieces of the bacteria to a carrier protein, which prompts a stronger, longer-lasting immune response — including in infants, whose immune systems don't respond well to older vaccine types. The numbers refer to how many strains of pneumococcal bacteria each vaccine targets. These PCVs are:

  • PCV15
  • PCV20
  • PCV21

PCV 21, or pneumococcal 21-valent conjugate vaccine (Capvaxive), is FDA-approved to help prevent invasive pneumococcal disease in adults and in children and teens ages 2 through 17 who have completed a primary pediatric pneumococcal vaccination series and have one or more chronic medical conditions that put them at increased risk for pneumococcal disease. In adults 18 and older, the vaccine is also approved to help prevent pneumococcal pneumonia. Ask your doctor whether you or your child should get this vaccine and when.

An older type of vaccine called pneumococcal polysaccharide vaccine 23 (PPSV23) is used in a follow-up role — most often given after PCV15 in certain adults and in some children over 2 with specific health conditions. PPSV23 covers more strains than the PCVs but produces a weaker immune response and, unlike the conjugate vaccines, doesn't reduce the bacteria carried in the nose and throat that spread the disease.

Pneumococcal vaccine for babies and young children

PCV15 and PCV20 are the two vaccines recommended for children under 5. Infants receive four doses, at 2 months, 4 months, 6 months, and 12–15 months.  Infants and very young children are at higher risk for several dangerous infections, including pneumonia and bacterial meningitis. 

Pneumococcal vaccine for children

Children over 5 who weren't fully immunized earlier, or who have certain medical conditions (such as chronic kidney disease), may need additional doses. Depending on which vaccines they've already had, this is usually a dose of PCV15 or PCV20 — and if PCV15 is used, PPSV23 is given at least 8 weeks later. The exact schedule depends on how many pneumococcal shots the child had before and their medical conditions.

Pneumococcal disease is an infection caused by the bacteria Streptococcus pneumoniae or pneumococcus. People can be infected with the bacteria, or they can carry it in their throats and not be ill. Those carriers can still spread it, primarily in droplets from their nose or mouth when they breathe, cough, or sneeze.

What does the pneumococcal vaccine prevent?

The pneumococcal vaccine helps prevent several pneumococcal diseases caused by the Streptococcus pneumoniae, including:

  • Bacterial meningitis, an infection of the covering of the brain and spinal cord that can lead to confusion, coma, death, and other physical effects, such as blindness or paralysis
  • Pneumonia, an infection of your lungs that leads to cough, fever, and difficulty breathing
  • Otitis media, a middle ear infection that can cause pain, swelling, sleeplessness, fever, and irritability
  • Bacteremia, a dangerous infection in your bloodstream
  • Sinus infections

There are more than 3,500 deaths each year in the U.S. as a result of pneumococcal disease. More than half of those deaths are in adults who should have been vaccinated, according to the CDC.

Worldwide, pneumonia is the leading cause of death in children under 5 and the most common reason for children to be hospitalized in the U.S. After the launch of PCVs in 2000, rates of pneumococcal diseases began falling dramatically in children and adults.

The vaccines are generally safe. As with any medicine, there's always the possibility of a serious problem, such as an allergic reaction. But the risk of serious harm or death is very small.

In studies involving nearly 60,000 doses of the PCV vaccine, there were no moderate or severe reactions. The mild side effects included:

  • Redness, tenderness, or swelling where the shot was given in about 1 out of every 4 infants
  • Fever higher than 100.4 F in about 1 out of every 3 infants
  • Fever higher than 102.2 F in about 1 out of every 50 children
  • Occasional cases of fussiness, drowsiness, or loss of appetite

About 1 out of every 2 adults who receive the PPSV vaccine have redness or pain where the shot is given. Less than 1% have a more severe reaction, such as a fever or muscle aches.

The PCV vaccine is recommended for the following children and adults:

Pneumococcal vaccine safe schedule

All infants younger than 24 months should receive four doses of the vaccine, using the following schedule:

  • First shot at 2 months
  • Second shot at 4 months
  • Third shot at 6 months
  • Booster at 12-15 months

Children who don't get their shot at these times should still get the vaccine. The number of doses and time between doses will depend on the child's age.

Healthy children aged 2-5 years who didn't complete the four doses or didn't receive any doses should receive one dose of the vaccine.

Children aged 6–18 who are at high risk of pneumococcal disease may need an extra dose of a PCV (PCV15 or PCV20) even if they completed their shots as infants.  

Healthy adults over 50 should get:

  • One dose of PCV15 followed by a dose of PPSV23 at least a year later, or
  • One dose of PCV20, or 
  • One dose of PCV21

Adults aged 19 to 49 who are at an increased risk for pneumococcal disease follow the same pneumococcal vaccine guidelines as for healthy adults over 50. Examples of increased risk include long-term use of steroids, chemotherapy, or radiation therapy.

In addition, people aged 2–49 with a condition that raises their risk should be vaccinated. The vaccine of choice is a PCV (PCV15, PCV20, or PCV21 depending on age); when PCV15 is used, PPSV23 follows later. Qualifying conditions include:

  • Hodgkin's disease
  • Lymphoma or leukemia
  • Kidney failure
  • Multiple myeloma
  • Nephrotic syndrome
  • HIV infection or AIDS
  • Damaged spleen or no spleen
  • Organ transplant
  • Heart disease
  • Lung disease
  • Sickle cell disease
  • Diabetes
  • Alcoholism
  • Cirrhosis
  • Cerebrospinal fluid leak
  • Cochlear implant

If PCV15 is used, PPSV23 is generally given at least a year later — or as soon as 8 weeks later for people who are immunocompromised or who have a cochlear implant or cerebrospinal fluid leak. Talk to your doctor about whether any additional doses are recommended for your situation.

For kids ages 2 through 17, PCV21 should be given only after they have completed a primary pediatric pneumococcal vaccination series and only if they have one or more chronic medical conditions that put them at increased risk for pneumococcal disease. Ask your doctor whether you or your child should get this vaccine and when.

Side effects of the pneumococcal vaccine are minimal. For the pneumococcal conjugate vaccines (PCV15, PCV20, PCV21), possible side effects include:

  • Redness, swelling, pain, or tenderness in the area where you got the shot
  • Chills or fever
  • Loss of appetite
  • Tiredness
  • Headache or joint pain
  • Irritability in young kids

For PPSV23, the possible side effects are:

  • Redness, swelling, pain, or tenderness in the area where you got the shot
  • Fever
  • Tiredness
  • Muscle aches

If you do notice side effects, they're usually mild and gone within two days.

In 2024, the CDC recommended lowering the age for pneumococcal vaccine from 65 to 50. And for a good reason.

"While invasive pneumococcal infection rates and mortality are highest in those aged 65 years and older (as the basis for the previous adult recommendation), adults aged 50-64 years have the second highest rate of disease," says Monica M. Farley, MD, President-Elect, National Foundation for Infectious Diseases and professor emerita of infectious diseases at Emory University School of Medicine. "In fact, disease rates peak among Black adults between age 55-59 years." 

So, getting vaccinated after you turn 50 is very important. "Getting vaccinated against pneumococcal disease can help protect adults age 50 years and older against serious disease, especially those who have medical conditions such as heart disease, lung disease (asthma or COPD), and liver disease or those who are immunocompromised," she says.

If you're over the age of 50 or have an underlying medical condition that puts you at risk and haven't had a pneumococcal vaccine, talk to your doctor and ask to schedule one. According to the National Foundation for Infectious Disease, the death rates from bacteremia and meningitis caused by invasive pneumococcal disease are very high in older people and people who have underlying medical conditions. Bacteremia kills about 1 in 8 adults, and pneumococcal meningitis kills about 1 in 6 older adults who are infected.

Pneumococcal disease can cause breathing problems and serious infections such as pneumonia and meningitis. Luckily, there are several vaccines available. These are targeted mainly at children under 5 and adults over 50, as these are the age groups most likely to get pneumococcal diseases. However, people of other ages who have certain medical conditions may also wish to get the vaccine or a booster.

Is the pneumococcal vaccine really necessary?

Yes, if you're in a higher-risk group, such as under 5, over 50, or have a medical condition that may affect your immune system. These medical conditions include Hodgkin's disease, lymphoma, and kidney disease. Children and teens who never received their pneumococcal shots as infants should still get the shot

What is the cost of a pneumococcal vaccine?

The price varies widely depending on whether you have insurance and where you get your vaccine from. Most your insurance plans fully cover vaccinations and you don't have to pay anything extra. If you don't have insurance, you could pay around $160-$200. Price may vary depending on the type of pneumococcal vaccine you get.

Add WebMD as a Preferred Source to see more of our trusted content across Google Search, AI Overviews, and AI Mode