Annexe A: priority groups for pneumococcal polysaccharide 23-valent vaccine (PPV23, Pneumovax®23)

Published 30 April 2021

Priority groups for PPV23 vaccination

Clinical risk group Examples (decision based on clinical judgement)
High priority    
Asplenia or dysfunction of the spleen This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction  
Immunosuppression Due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, asplenia or splenic dysfunction, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (for example, IRAK-4, NEMO, complement deficiency). Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age), or for children under 20kg, a dose of 1mg or more per kg per day  
Individuals with cerebrospinal fluid leaks This includes leakage of cerebrospinal fluid such as following trauma or major skull surgery (does not include CSF shunts)  
Individuals with cochlear implants It is important that immunisation does not delay the cochlear implantation  
Moderate priority    
Chronic respiratory disease This includes chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children with respiratory conditions caused by aspiration, or a neurological disease (for example, cerebral palsy) with a risk of aspiration. Asthma is not an indication, unless so severe as to require continuous or frequently repeated use of systemic steroids (as defined in Immunosuppression)  
Chronic heart disease This includes those requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure  
Chronic kidney disease Nephrotic syndrome, chronic kidney disease at stages 4 and 5 and those on kidney dialysis or with kidney transplantation  
Chronic liver disease This includes cirrhosis, biliary atresia and chronic hepatitis  
Diabetes Diabetes mellitus requiring insulin or oral hypoglycaemic drugs. This does not include diabetes that is diet controlled  
Low priority    
Healthy individuals aged 65 years and over. Booster doses for asplenics, those with splenic dysfunction and chronic kidney disease