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For people with Down syndrome, family members, caregivers and professionals.

Pneumococcal Vaccines

April 2022 | Brian Chicoine, MD, Erin Dominiak, MD, and Hannah Graham, MD - Adult Down Syndrome Center

April 2022: We updated this resource to include information about Prevnar 20 (pneumococcal conjugate vaccine, PCV20).

What is pneumococcal disease? 

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. It is a leading cause of vaccine-preventable illness and death in the United States. Anyone can get pneumococcal disease, but some people are at greater risk than others: 

  • People age 65 years and older
  • The very young
  • People with certain health problems
  • People with a weakened immune system
  • People who smoke

Pneumococcal disease can lead to serious infections of the: 

  • Lungs (pneumonia)
  • Blood (bacteremia)
  • Covering of the brain (meningitis)

According to the Centers for Disease Control and Prevention (CDC), pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year in the United States. Pneumococcal bacteremia and meningitis caused approximately 3,250 deaths in the United States in 2019. 

Studies on pneumonia and respiratory infections have shown that pneumonia more commonly affects people with Down syndrome compared to people without Down syndrome. A study of patients in our health system found that people with Down syndrome had 4 times greater odds of developing pneumonia than people without Down syndrome. Pneumonia is a common problem treated at the Adult Down Syndrome Center, a frequent cause for admission to the hospital, and one of the leading causes of death in patients served at the Center. 

How can pneumococcal disease be prevented? 

Pneumococcal vaccines help prevent pneumococcal disease.

There are two pneumococcal vaccines in the United States: 

  • Pneumococcal conjugate vaccines (PCV13 or Prevnar 13, PCV15 or Prevnar 15, PCV20 or Prevnar 20)

  • Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23)

Who should get pneumococcal vaccines?

The CDC recommendations are as follows: 

  • PCV13 is recommended for all children younger than 2 years old.

  • PCV13 and PPSV23 are recommended for children between 2 and 18 years of age who have certain medical conditions.

  • PCV15 or PCV20 are recommended for adults who have never received a pneumococcal conjugate vaccine and are:

    • 65 years and older

    • 19 through 64 years old and have certain medical conditions or other risk factors. 

  • If PCV15 is used, it should be followed by a dose of PPSV23. 

Additional information is available in the CDC's Vaccine Information Statement for PCV13, 15, and 20 and the CDC's Vaccine Information Statement for PPSV23.

What are the "certain medical conditions" that indicate that someone 19 through 64 years of age should be vaccinated against pneumococcal disease?

The medical conditions and the timing of the indicated pneumococcal vaccine vary by age. For adults who are 19 through 64 years old, pneumococcal vaccines are indicated if the adult has any of the conditions listed below: 

  • Alcoholism
  • Cerebrospinal fluid leaks
  • Chronic heart disease, including congestive heart failure and cardiomyopathies
  • Chronic liver disease
  • Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
  • Chronic renal failure
  • Cigarette smoking
  • Cochlear implant
  • Congenital or acquired immunodeficiency
  • Diabetes mellitus
  • Generalized malignancy
  • HIV infection
  • Hodgkin disease
  • Iatrogenic immunosuppression, including long-term systemic corticosteroids and radiation therapy
  • Leukemia
  • Lymphoma
  • Multiple myeloma
  • Nephrotic syndrome
  • Sickle cell disease or other hemoglobinopathies
  • Solid organ transplant

Additional information about the type of vaccine, number of doses, and timing of doses indicated for these conditions can be found on the CDC's Summary of Who and When to Vaccinate page.

What should people with Down syndrome consider? 

Down syndrome is not specifically listed as a "certain medical condition" that indicates that someone should get a pneumococcal vaccine between the ages of 19 and 64. However, as mentioned above, pneumonia occurs more frequently in people with Down syndrome. Additionally, immune system deficiency (which is listed above) is a common finding in people with Down syndrome. Therefore, at the Adult Down Syndrome Center, we include Down syndrome in the list of conditions that indicates that someone between the ages of 19 and 64 should be vaccinated against pneumococcal disease.

As stated above, the CDC recommends pneumococcal vaccines for adults starting at age 65 (even if they do not have certain medical conditions). People with Down syndrome start to experience aging issues at a younger age, so we have lowered the age to 50 years at our Center. We recommend pneumococcal vaccines for most individuals with Down syndrome who receive medical care at our Center.

What is our approach?

For an adult with Down syndrome who has not received any pneumococcal vaccines as an adult (age 19 or older): 

  • We recommend PCV20.


For an adult with Down syndrome who has received one PPSV23:

  • We wait one year after the PPSV23 dose and then recommend PCV20.


For an adult with Down syndrome who has received two PPSV23 vaccines:

  • We wait one year after the second PPSV23 and then recommend PCV20. 


For an adult with Down syndrome who has received one dose of PCV13 but not PPSV23:

  • We recommend waiting one year and then getting PPSV23. A second dose of PPSV23 is recommended 5 years later if the person was younger than age 50 when they received their first PPSV23. We recommend a third dose of PPSV23 once 5 years have passed since the second dose and the person is age 50 or older.


For an adult with Down syndrome who is 50 years old and received one or two doses of PPSV23 before age 50: 

  • We wait until 1 year after the last PPSV23 and then recommend PCV20.


For an adult with Down syndrome who is 50 years old and has not received pneumococcal vaccines: 

  • We recommend PCV20.


There are many factors to consider when deciding which pneumococcal vaccines to get, at what age to get them, and how many doses to get. Our approach is a modification of the recommendation of the CDC based on the experience of serving individuals with Down syndrome at the Adult Down Syndrome Center. This information should be discussed with your healthcare provider and not taken as a personal medical recommendation.

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Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.