Pneumococcal vaccines – frequently asked questions (FAQs)

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NCIRS fact sheets, FAQs and other resources

Key points

  • Pneumococcal disease is a group of clinical conditions caused by the bacterium Streptococcus pneumoniae (also called pneumococcus). The most severe form is known as invasive pneumococcal disease (IPD).
     
  • Different types of pneumococci are called serotypes. Over 100 serotypes have been identified, but only a limited number cause disease. Pneumococcal vaccines vary in the number of serotypes they cover. 
     
  • The number in the name of each pneumococcal vaccine represents the number of different serotypes it contains. For example, 13-valent pneumococcal conjugate vaccine (13vPCV) contains 13 serotypes. 
     
  • Pneumococcal vaccination is recommended for infants and children aged under 5 years, all people with specified risk conditions, First Nations adults aged 50 years and over and non-First Nations adults aged 70 years and over.
     
  • Two types of pneumococcal vaccines are currently registered for use in Australia: (i) pneumococcal conjugate vaccines (PCVs); and (ii) a pneumococcal polysaccharide vaccine (PPV). These vaccine types are not interchangeable. They do not contain live bacteria, so they cannot cause pneumococcal disease.
     
  • Pneumococcal vaccine recommendations – such as vaccine type, vaccine brand, number of doses and interval between doses – vary depending on several factors, including the person’s age, immune status and First Nations status; their state or territory of residence; and whether or not they have previously received doses of a pneumococcal vaccine. 
     
  • Two pneumococcal vaccines are funded under the National Immunisation Program (NIP): one PCV (13vPCV) and one PPV (23vPPV). 23vPPV is used for additional doses following PCV for certain populations. 
     
  • Two other PCVs – a 15vPCV and a 20vPCV – are registered for use in Australia but not currently funded under the NIP. These are available as privately funded vaccines.
     
  • Australia’s pneumococcal vaccination program is currently under review.

FAQs

What is pneumococcal disease?

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria (also known as pneumococci). 

These bacteria, which are often found in the nose and throat without causing disease – this is known as asymptomatic nasopharyngeal carriage – can spread to other people through saliva and mucus. 

Pneumococci can spread to other parts of the body, such as the middle ear, blood, brain and lungs, and can cause disease. 

The more severe forms of pneumococcal illnesses – where the bacteria enters body sites that are normally ‘sterile’ – are collectively known as invasive pneumococcal disease (IPD). IPD can be associated with severe long-term consequences and even death.

Who can get pneumococcal disease?

Anyone can develop pneumococcal disease; however, those at greatest risk of disease and severe outcomes are:

  • infants and young children
  • older adults
  • people with certain risk conditions. 

As people age, their immune systems naturally decline, and this increases susceptibility to pneumococcal disease.

First Nations people are also disproportionately impacted by severe pneumococcal disease. 

How common is pneumococcal disease? 

The total number of IPD cases in Australia in 2023 was 2,265. The highest proportion of these cases were in infants and children aged less than 5 years (16%) and adults aged over 65 years (43%).

In 2016, the rate of IPD in Australia was 6.9 per 100,000 individuals. The highest notification rate was among those aged 85 years and over (34.0 per 100,000 individuals); in children, it was among those aged less than 5 years (14.9 per 100,000 individuals). 

First Nations people are disproportionatel6y impacted by severe pneumococcal disease. In 2016, the rate of IPD in First Nations people was approximately six times that of the non-First Nations population.

Pneumococcal-related cases of middle ear infections (otitis media) and lung infections (pneumonia) are several-fold more common than severe disease. 

Pneumococcal disease has a seasonal pattern and is more commonly seen in the winter months. 

More data on the incidence of IPD can be found here.

Which pneumococcal vaccines are available in Australia?

There are two types of pneumococcal vaccines: 

  • pneumococcal conjugate vaccine (PCV)
  • a pneumococcal polysaccharide vaccine (PPV). 

These two vaccine types are not interchangeable. 

These vaccines are inactivated, meaning they do not contain live bacteria and cannot cause pneumococcal disease. 

Currently, four pneumococcal vaccines – three PCVs and one PPV – are registered for use in Australia: 

  • 13vPCV (13-valent pneumococcal conjugate vaccine [Prevenar 13]): Registered for use in people aged 6 weeks and over; NIP-funded for certain groups
  • 15vPCV (15-valent pneumococcal conjugate vaccine [Vaxneuvance]): Registered for use in people aged 6 weeks and over; not NIP-funded
  • 20vPCV (20-valent pneumococcal conjugate vaccine [Prevenar 20]): Registered for use in people aged 6 weeks and over; not NIP-funded
  • 23vPPV (23-valent pneumococcal polysaccharide vaccine [Pneumovax 23]): Registered for use in people aged 2 years and over; NIP-funded for certain groups.

For more information about each of these vaccines, see ‘Pneumococcal vaccines available in Australia’ in the Australian Immunisation Handbook. 

How are pneumococcal conjugate vaccines (PCVs) and the pneumococcal polysaccharide vaccine (PPV) different?

Pneumococcal conjugate vaccines (PCVs) and the polysaccharide vaccine (PPV) both contain a polysaccharide (sugar) of the different pneumococcal serotypes (strains). However: 

  • the polysaccharides in PCVs are attached to a ‘helper’ protein (conjugation) 
  • the polysaccharides in the PPV are not attached to a ‘helper’ protein. 

Attachment to the helper protein makes the immune response to PCVs stronger and longer-lasting than the immune response to PPV. 

Are pneumococcal vaccines interchangeable?

No – PCVs and PPV are not interchangeable.

For infants and children who are recommended multiple doses of PCV, it is recommended to finish a schedule of pneumococcal vaccination with the same PCV with which the schedule was started. 

However, if the same vaccine is not available – or if an individual has a personal preference to complete their schedule with a different PCV (i.e. to be protected against additional serotypes by a higher-valency vaccine) – then they may receive a different PCV.

For those recommended to receive PPV, only one vaccine is available (23vPPV).

Who should receive pneumococcal vaccination? 

Pneumococcal vaccination is recommended for:

  • infants and children aged up to 5 years
  • people of all ages with specified medical risk conditions
  • First Nations adults aged 50 years and over
  • non-First Nations adults aged 70 years and over.
Who is eligible to receive a free pneumococcal vaccine under the NIP?

13vPCV and 23vPPV are the two pneumococcal vaccines currently funded under the NIP. 

13vPCV is NIP-funded for:

  • infants and children aged under 5 years
  • First Nations adults aged 50 years and over
  • non-First Nations adults aged 70 years and over
  • people of all ages with specified medical risk conditions.

23vPPV is NIP-funded in addition to 13vPCV for: 

  • First Nations infants and children aged under 5 years living in the Northern Territory, Queensland, South Australia and Western Australia
  • First Nations adults aged 50 years and over
  • people with specified medical risk conditions aged 2 years and over.
How are pneumococcal vaccines administered? 

All PCVs (i.e. 13vPCV, 15vPCV and 20vPCV) are administered via intramuscular injection. 

The preference is for polysaccharide vaccine (23vPPV) to be administered as an intramuscular injection, but it can also be administered subcutaneously. 

For more information see ‘Vaccines, dosage and administration’ in the Australian Immunisation Handbook.

What are the common side effects after receiving pneumococcal vaccines?

Injection site reactions – such as pain, tenderness, redness and swelling – may occur in both children and adults following pneumococcal vaccination. Other general side effects can include muscle aches and pains, fatigue, irritability and chills. 

These symptoms are typically mild and resolve within a few days. 

13vPCV, 15vPCV, 20vPCV and 23vPPV have similar side effects. Injection site side effects are more common after the second dose of 23vPPV than after the first dose. 

Is there potential for any rare serious adverse events following pneumococcal vaccination?

There are no substantial concerns regarding serious adverse events following pneumococcal vaccination; however, there may be a rare possibility of increased risk of fever and febrile convulsions if 13vPCV is given at the same time as an influenza vaccine. (See ‘What are the common side effects after receiving pneumococcal vaccines?’)

One US study found a slight increase in the risk of fever and febrile convulsions in infants who received 13vPCV at the same time as influenza vaccine. A later study, however, did not find the same association for 13vPCV, and no association has been seen in co-administration studies for 15vPCV.

There are no other concerns regarding the potential for serious adverse events.

For more information, see ‘Adverse events’ in the pneumococcal disease chapter of the Australian Immunisation Handbook.

Can a person receive other vaccines at the same time as pneumococcal vaccines?

Yes. 

Infants can receive pneumococcal vaccines at the same time as other vaccines given in childhood, including influenza vaccines. 

Adults can receive pneumococcal vaccines at the same time as most other adult vaccines. 

If more than one vaccine is given in the same limb, there should be a minimum 2.5 cm gap between injection sites.

When should children and infants aged less than 5 years receive their pneumococcal vaccines, and what vaccine should they have?

Infants without risk conditions and First Nations infants living in ACT, New South Wales, Tasmania and Victoria are recommended to receive a 3-dose PCV schedule (known as ‘2+1’ – i.e. 2 initial doses and 1 booster dose). Their schedule is as follows:

  • 1 dose of PCV at 2 months of age
  • 1 dose of PCV at 4 months of age
  • 1 dose of PCV at 12 months of age.

First Nations children living in the Northern Territory, Queensland, South Australia and Western Australia, as well as infants and children with a risk condition(s) for pneumococcal disease, are recommended to receive a 4-dose PCV schedule (known as ‘3+1’ – i.e. 3 initial doses and 1 booster dose). In addition, they are recommended to receive 2 doses of PPV. Their schedule is as follows:

  • 1 dose of PCV at 2 months of age
  • 1 dose of PCV at 4 months of age
  • 1 dose of PCV at 6 months of age
  • 1 dose of PCV at 12 months of age
  • 1 dose of 23vPPV at 4 years of age 
  • a second dose of 23vPPV at least 5 years after the first dose of 23vPPV.

When selecting a PCV, there is no preference for either 13vPCV or 15vPCV. However, only 13vPCV is funded (for eligible children) under the NIP.

20vPCV is also registered for use in infants and children. 

23vPPV is the only polysaccharide vaccine available for those who require doses of a PPV.

Information about state and territory immunisation schedules is available here.

For more detailed clinical advice, see ‘Infants and children’ in the pneumococcal disease chapter of the Australian Immunisation Handbook.

What are the pneumococcal vaccine recommendations for infants aged under 12 months with risk conditions?

Infants aged under 12 months who are diagnosed with a risk condition are recommended to receive the 3-dose schedule at 2, 4 and 12 months of age, plus the following additional doses: 

  • 1 dose of PCV at 6 months of age (only 13vPCV is funded under the NIP. Additional doses should be the same PCV as primary doses)
  • 1 dose of 23vPPV at 4 years of age 
  • a second dose of 23vPPV at least five years after the first dose of 23vPPV.
When should non-First Nations adults with no risk conditions receive the pneumococcal vaccine?

A single dose of a PCV (i.e. 13vPCV, 15vPCV or 20vPCV) is recommended for all non-First Nations adults without risk conditions at 70 years of age. 

If a person does not receive a dose of a PCV at age 70, they are recommended to receive one as soon as possible. 

There is no preference between PCV vaccines (13vPCV, 15vPCV or 20vPCV); however, only 13vPCV is NIP-funded for this group. 

For more information, see ‘Adults’ and ’Pneumococcal vaccination recommendations for people who have previously received a pneumococcal vaccine' in the pneumococcal disease chapter of the Australian Immunisation Handbook.

When should First Nations adults with no risk conditions receive pneumococcal vaccines?

First Nations adults with no risk conditions for pneumococcal disease are recommended to receive:

  • 1 dose of a PCV at age 50 years (there is no preference between PCVs; however, only 13vPCV is funded under the NIP at this age)
  • 1 dose of 23vPPV 12 months later
  • a second dose of 23vPPV at least five years after the first dose of 23vPPV.

If a person has not received a dose at age 50, they are recommended to receive one as soon as possible.

For more information, see ‘Recommendations – Aboriginal and Torres Strait Islander people’ and ‘Pneumococcal vaccination recommendations for people who have previously received a pneumococcal vaccine' in the pneumococcal disease chapter of the Australian Immunisation Handbook.

What are the pneumococcal vaccine recommendations for all people aged 12 months and over with risk conditions?

Anyone aged 12 months and over who is newly diagnosed with a risk condition is recommended to receive additional doses of pneumococcal vaccine, as follows:.

  • 1 dose of a PCV at the time of diagnosis (at least 2 months after any previous dose of a PCV) – noting that only 13vPCV is funded under the NIP and that the same PCV should be used for additional doses as for primary doses; and
  • a dose of 23vPPV 12 months after the PCV dose (2–12 months later is acceptable); and
  • a second dose of 23vPPV at least five years after the first dose of 23vPPV. 

First Nations infants and children aged up to 5 years living in Northern Territory, Queensland, South Australia and Western Australia, as well as First Nations adults aged 50 years and over (in all states and territories), are already recommended and funded to receive additional doses. No further doses are required for these First Nations adults or children, regardless of risk condition status.

For more information, see ‘People with risk conditions’ and ‘Pneumococcal vaccination recommendations for people who have previously received a pneumococcal vaccine' in the pneumococcal disease chapter of the Australian Immunisation Handbook.

What catch-up vaccines are recommended if a person has missed a dose of pneumococcal vaccine?

For infants and children who have missed a dose of pneumococcal vaccine, the number of doses and the pneumococcal vaccine required will depend on where the child lives, First Nations status, presence of a risk condition, number of previous pneumococcal vaccine doses received, current age and the age at which the previous dose was administered. 

An immunisation provider can assist with a catch-up schedule; catch-up resources are listed in the ‘Useful links’. 

Adults who are recommended a pneumococcal vaccine and have not yet received one should receive a vaccine as soon as possible. The vaccine type and number of doses will be based on the person’s age, First Nations status and whether they have any conditions associated with an increased risk of IPD.

The additional pneumococcal vaccine doses some people are recommended to receive will also depend on which doses they have previously received. See ‘Pneumococcal vaccination recommendations for people who have previously received a pneumococcal vaccine'. 

For more detailed recommendations and catch-up resources, refer to the Australian Immunisation Handbook.

What is the recommended interval between doses of the different types of pneumococcal vaccines?

The recommended interval between a dose of any PCV (13vPCV, 15vPCV, 20vPCV) and a dose of 23vPPV is 12 months. However, the order in which the vaccines are given may allow for a shorter interval in certain circumstances – specifically:

  • A 12-month interval is recommended between a dose of PCV and a subsequent dose of 23vPPV; however, an interval of 2–12 months is acceptable. (Note: If a person has already had a dose of 23vPPV prior to their dose of PCV, the second dose of 23vPPV should be given at least five years after the previous dose of 23vPPV or 2–12 months after the dose of PCV – whichever is later.)
  • A minimum interval of five years is recommended between a dose of 23vPPV and a second dose of 23vPPV. 
  • A minimum interval of 12 months is recommended between a dose of 23vPPV and any subsequent dose of PCV.
What is the interval between having pneumococcal disease and receiving a pneumococcal vaccine?

Pneumococcal vaccination can occur once a person has recovered from pneumococcal disease.

There is currently no evidence to suggest an instance of pneumococcal disease provides protection from future disease.

There are data that suggest those who have had IPD are at increased risk of pneumococcal disease in future. This is considered a risk condition, and people who have had IPD are recommended to receive additional doses of pneumococcal vaccine.

Should a person receive a dose of a new higher-valency pneumococcal vaccine if they have previously received another vaccine?

There are currently no recommendations for additional doses of either the 15vPCV or 20vPCV vaccines if a person has already received an age-appropriate schedule of 13vPCV or 15vPCV.

Should a person complete their recommended schedule with a dose of a higher-valency pneumococcal conjugate vaccine if they have previously received a lower-valency conjugate vaccine?

No, a person does not need to complete their schedule with a higher-valency pneumococcal vaccine if they started it with a lower valency vaccine. Individuals should complete their recommended schedule with the same PCV with which it started. 

However, in circumstances where that PCV is not available or a higher-valency conjugate vaccine is preferred, the schedule can be completed with a different PCV (noting that only 13vPCV is funded under the NIP). As noted earlier, the conjugate and polysaccharide vaccines are not interchangeable.

How many doses of 23vPPV should a person receive over their lifetime? 

First Nations adults, certain First Nations infants and children and people with risk conditions of all ages (including those who are newly diagnosed) are recommended to receive 23vPPV. These groups should receive 2 doses five years apart, and no additional doses are required later in life. 

Doses of 23vPPV given during childhood are counted when determining the number of further doses required. There is no current evidence to support the administration of more than 2 doses of 23vPPV, and the risk of adverse reactions is higher with repeat doses. 

For those who have never received a PCV and are also recommended to receive doses of 23vPPV, the PCV dose should be given first.

Is there anyone who should not receive pneumococcal vaccines?

The only absolute contraindication for pneumococcal vaccines is anaphylaxis (a severe allergic reaction) after a previous dose of the relevant vaccine or its components.

Should pregnant women receive pneumococcal vaccines?

In most situations, pregnant women who are recommended to receive a pneumococcal vaccine should wait until after the pregnancy to receive the vaccine. However, inadvertent administration during pregnancy is unlikely to result in serious adverse effects. 

Vaccination may be considered for pregnant women who are at high risk of IPD and were not vaccinated before pregnancy. Healthcare providers can give individual advice or seek further guidance from their state or territory specialist immunisation service.

How effective are pneumococcal vaccines?

Among Australian children, 3 doses of 13vPCV is around 90% effective in preventing IPD caused by the serotypes included in the vaccine. Due to the strong ‘herd effect’, the introduction of PCVs has also led to large declines in disease in older age groups.

A universal childhood PCV program was introduced in Australia in 2005. Between that year and 2016, the overall incidence of IPD caused by serotypes included in the vaccine declined by 40%. Among infants, the decline in this vaccine-type IPD incidence rate was 80% and in adults aged 65 years and over the decline was 32%.

Pneumococcal vaccination programs have also led to a reduction in hospitalisations due to pneumonia and middle ear infections. 

The impact of these programs has, however, been lower among First Nations people and people with underlying medical conditions that increase their susceptibility to pneumococcal disease.

Data on the impact of the introduction of higher-valency pneumococcal vaccines in Australia are still emerging.

If the 23vPPV vaccine protects against more strains than 13vPCV, then why do we still need to give 13vPCV to people who are eligible to receive 23vPPV?

The conjugate and polysaccharide vaccines protect against pneumococcal disease in different ways. People at higher risk of pneumococcal disease are likely to benefit from both types of protection.

Why are pneumococcal vaccines NIP-funded for certain groups but not for others? 

The risk of pneumococcal disease varies widely among people based on a range of factors, including age and underlying medical conditions. 

The Pharmaceutical Benefits Advisory Committee provides advice and recommendations to the Australian Government Department of Health and Aged Care to inform these decisions. For more information, see National Immunisation Program (NIP) vaccine listing process.

What is the scientific evidence behind the Australian Technical Advisory Group on Immunisation (ATAGI) recommendations for pneumococcal vaccines?

Current ATAGI recommendations for pneumococcal vaccination – which are included in the Australian Immunisation Handbook – were made following thorough review of evidence, including Australian data, by immunisation experts. 

NCIRS supported this work through use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The GRADE assessments for pneumococcal vaccines are available here.

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