GPAtlas🧭 When to offer pneumococcal vaccination
Pneumococcal disease describes infections caused by Streptococcus pneumoniae, ranging from otitis media and sinusitis to invasive pneumococcal disease (IPD) – bacteraemic pneumonia, septicaemia and meningitis. Risk is highest at the extremes of age and in those with impaired immunity or chronic disease. Pneumococcal meningitis is a notifiable disease.
Vaccination is delivered through three strands: the routine infant programme, a one-off dose for adults at 65, and protection for clinical risk groups aged 2 and over (with an additional occupational indication for welders). The key 2025–26 change to know is that PCV20 (Prevenar 20) is replacing PPV23 (Pneumovax 23) in the adult and at-risk programmes; the routine infant vaccine, PCV13 (pneumococcal conjugate vaccine), is unchanged, but its first dose now falls at 16 weeks.
The primary-care task is to identify eligible patients opportunistically – at annual reviews, on new diagnoses, and especially on hospital discharge – and to know precisely which conditions qualify and which do not.
| Group | Who is eligible | Vaccine & schedule |
|---|---|---|
| Routine infants | All infants as part of the childhood programme | PCV13 at 16 weeks + booster at 1 year (a 1+1 schedule) |
| Adults 65 and over | A single dose at 65 (and those over 65 not previously vaccinated) | Single one-off dose of PCV20 (or PPV23 while stocks last) |
| Clinical risk groups (2–64) | Specific long-term conditions (detailed below) | Single dose of PCV20 (or PPV23); 5-yearly only if asplenia, splenic dysfunction or chronic kidney disease |
| Occupational risk | Frequent or continuous exposure to metal fumes (e.g. welders) | Single dose of PCV20 (or PPV23) |
| Clinical risk group (aged 2–64) | Key inclusions and exclusions |
|---|---|
| Asplenia or splenic dysfunction | Includes coeliac disease with splenic dysfunction, and all haemoglobinopathies (e.g. homozygous sickle cell disease) |
| Chronic respiratory disease | Chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis, bronchopulmonary dysplasia. Asthma qualifies only if it requires continuous or frequently repeated systemic steroids |
| Chronic heart disease | Ischaemic and congenital heart disease, chronic heart failure, hypertension with cardiac complications |
| Chronic kidney disease | Nephrotic syndrome, chronic kidney disease stages 4–5, dialysis or transplant |
| Chronic liver disease | Cirrhosis, biliary atresia, chronic hepatitis |
| Diabetes | Requiring insulin or anti-diabetic medication; diet-controlled diabetes alone does not qualify |
| Immunosuppression | Disease or treatment – chemotherapy, bone marrow transplant, HIV at any stage, multiple myeloma, complement disorder; or systemic steroids for > 1 month at ≥ 20 mg/day prednisolone (or ≥ 1 mg/kg/day if under 20 kg) |
| Cochlear implants | Vaccinate, but do not delay the implantation itself |
| Cerebrospinal fluid (CSF) leak | Following trauma or skull surgery; a CSF shunt does not qualify |
|
⚠️ Common pitfall Over-calling eligibility. Diet-controlled diabetes, asthma not requiring regular systemic steroids, and a CSF shunt (as opposed to a CSF leak) do not qualify – check the precise wording before coding a patient as eligible. Equally, don't overlook the genuine but easily-missed groups, such as welders and patients discharged after invasive pneumococcal disease. |
Source: UKHSA Green Book Chapter 25 · UKHSA pneumococcal programme guidance
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