A SINGLE DOSE OF 0.5 ML OF THE 23-VALENT VACCINE, CONTAINING 25 MICROGRAMS OF EACH OF THE 23 POLYSACCHARIDE TYPES, IS GIVEN TO AT-RISK ADULTS AND CHILDREN OVER 5 YEARS OF AGE BY INTRAMUSCULAR INJECTION (OR SUBCUTANEOUSLY IF THERE ARE BLEEDING DISORDERS). THE VACCINE SHOULD BE GIVEN AT LEAST 2 WEEKS (BUT PREFERABLY 4 TO 6 WEEKS) BEFORE ELECTIVE SPLENECTOMY, CHEMOTHERAPY, OR OTHER IMMUNOSUPPRESSIVE TREATMENT. REVACCINATION IS NOT GENERALLY RECOMMENDED EXCEPT, AFTER 5 YEARS, IN PATIENTS LIKELY TO HAVE RAPIDLY DECLINING ANTIBODY CONCENTRATIONS (FOR EXAMPLE, THOSE WITH ASPLENIA OR SPLENIC DYSFUNCTION AND THOSE WITH NEPHROTIC SYNDROME).
THE 7-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IS GIVEN BY INTRAMUSCULAR INJECTION. IN THE UK IT IS RECOMMENDED THAT AT-RISK INFANTS UNDER 6 MONTHS SHOULD BE GIVEN 3 SINGLE DOSES OF 0.5 ML AT INTERVALS OF 1 MONTH, STARTING AT 2 MONTHS OF AGE, WITH A FOURTH DOSE GIVEN IN THE SECOND YEAR OF LIFE; THOSE AGED 6 TO 11 MONTHS SHOULD RECEIVE 2 DOSES AT LEAST ONE MONTH APART WITH A THIRD DOSE GIVEN IN THE SECOND YEAR OF LIFE; AND THOSE AGED 12 TO 60 MONTHS SHOULD RECEIVE 2 DOSES AT LEAST TWO MONTHS APART. THE 23-VALENT PNEUMOCOCCAL POLYSACCHARIDE VACCINE SHOULD ALSO BE GIVEN TO THE HIGHEST RISK CHILDREN (THOSE WITH ASPLENIA OR SPLENIC DYSFUNCTION AND THOSE WITH NEPHROTIC SYNDROME) AFTER THEIR SECOND BIRTHDAY AND AT LEAST 2 MONTHS AFTER THE FINAL DOSE OF CONJUGATE VACCINE.
IN THE USA, THREE DOSES OF THE 7-VALENT PNEUMOCOCCAL CONJUGATE VACCINE ARE RECOMMENDED AS PART OF THE ROUTINE PRIMARY IMMUNISATION SCHEDULE AT 2, 4, AND 6 MONTHS OF AGE. THE 23-VALENT PNEUMOCOCCAL POLYSACCHARIDE VACCINE SHOULD BE GIVEN TO HIGH-RISK GROUPS BETWEEN THE AGES OF 2 AND 18 YEARS IN ADDITION TO PREVIOUSLY ADMINISTERED 7-VALENT PNEUMOCOCCAL CONJUGATE VACCINE. THE 23-VALENT VACCINE IS ALSO USED IN AT-RISK ADULTS SIMILARLY TO THAT OUTLINED FOR THE UK ABOVE.