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Pneumococcal Vaccine, Polyvalent

Pronunciation: NEW-moe-KOK-al
Class: Vaccine, bacterial

Trade Names

Pneumovax 23
- Injection 25 mcg each of 23 polysaccharide isolates per 0.5 mL dose

Pneumo 23 (Canada)


Induces antibodies against 23 capsular types of Streptococcus pneumoniae . Type-specific antibody facilitates bacterial destruction by complement-mediated lysis.

Indications and Usage

Protection against pneumococcal pneumonia, pneumococcal bacteremia, and other pneumococcal infections.


Standard considerations.

Dosage and Administration

Adults and Children (2 yr of age and older)

Subcutaneous / IM 0.5 mL.

Booster dose

Using 23-valent vaccine, revaccinate recipients of 14-valent pneumococcal vaccine who are at highest risk of fatal pneumococcal infection (eg, asplenic patients). Revaccinate adults who received 23-valent vaccine 5 or more yr earlier if they are at highest risk or are likely to have rapid decline in antibody levels (eg, patients with asplenia, nephrotic syndrome, or renal failure; transplant recipients). Consider revaccination of children with nephrotic syndrome, asplenia, or sickle-cell anemia after 3 yr if these children would be younger than 10 yr of age at time of revaccination.

General Advice

  • For subcutaneous or IM administration only. Not for intradermal or IV administration.
  • Administer preferably in the deltoid muscle or lateral mid-thigh.
  • The Advisory Committee on Immunization Practices (ACIP) states that pneumococcal vaccine may be coadministered with other vaccines and at the same time as the influenza vaccine (by separate injection in the other arm).
  • Following pneumococcal vaccination, antibody levels decline after 5 to 10 yr. The ACIP states that revaccination may be needed to provide continued protection.


Store in refrigerator (36° to 46°F).

Drug Interactions

In patients anticipating immunosuppression, response to pneumococcal vaccine is best if administered at least 14 days prior to immunosuppressive chemotherapy or radiation. Avoid vaccination during chemotherapy or radiation therapy. Pneumococcal vaccine may be given as early as several months following completion of chemotherapy or radiation therapy for neoplastic disease. Pneumococcal vaccine may be given at the same time as influenza vaccine (by separate injection in the other arm) without an increase in adverse reactions or a decrease in antibody response to either vaccine.

Adverse Reactions


Asthenia, decreased limb mobility, febrile convulsion, Guillain-Barré syndrome, headache, malaise, paresthesia, radiculoneuropathy.


Rash, urticaria


Nausea, vomiting.


Hemolytic anemia in patients who have had other hematologic disorders, leukocytosis, lymphadenopathy, lymphadenitis, thrombocytopenia in patients with stabilized idiopathic thrombocytopenic purpura.


Anaphylactoid reactions, angioneurotic edema, serum sickness.


Erythema, soreness, swelling and induration, warmth.


Arthralgia, arthritis, myalgia.


Cellulitis, chills, fever (more than 102°F), increased serum C-reactive protein, pain, peripheral edema in the injected extremity.



Category C . Vaccinate if risk of disease outweighs risk to patients.




Safety and effectiveness in children younger than 2 yr of age not established.


A higher frequency and/or greater severity of reactions in some older individuals cannot be ruled out.


Epinephrine injection (1:1000) must be immediately available should an acute anaphylactoid reaction occur from any component of the vaccine.

Special Risk Patients

Use with caution in patients with severely compromised CV and/or pulmonary function in whom a systemic reaction would pose a significant risk.

Antibiotic prophylaxis

In patients who require penicillin (or other antibiotic) prophylaxis against pneumococcal infection, do not discontinue such prophylaxis after vaccination with pneumococcal vaccine.

Febrile illness

Any febrile illness or other active infection is reason for delaying use of the vaccine, except when withholding the agent entails even greater risk.

Pneumococcal meningitis

May not be effective in preventing pneumococcal meningitis in patients who have CSF leakage resulting from congenital lesions, skull fractures, or neurosurgical procedures.

Patient Information

  • Instruct parents on risks and benefits of vaccination.
  • Explain that tepid bath may reduce pain at injection site.
  • Advise parents to complete all immunizations.
  • Explain that low-grade fever is transient and should subside in 24 h.
  • Tell patient or parents to notify health care provider immediately if any serious adverse reactions occur (eg, shortness of breath, hives, wheezing).
  • This vaccine is usually only needed once.
  • Explain that vaccination with pneumococcal vaccine may not offer 100% protection from pneumococcal infection.

Copyright © 2009 Wolters Kluwer Health.