Indications & Dose: IMMUNIZATION AGAINST PNEUMOCOCCAL DISEASE IM/SC Adult 0.5mL given as single dose Child >2yrs: Same as adult dose. However, children at increased risk of invasive pneumococcal disease 0.5mL as single dose given only after immunization with 13 or 7 valent Pneumococcal vaccine. A minimum of 8 wk interval should be maintained between the last dose of 13 or 7 valent Pneumococcal vaccine and 23 valent Pneumococcal vaccine | REVACCINATION IM/SC Adult Patients at high risk of pneumococcal infection like asplenia or with immunocompromising conditions: 0.5mL as single dose after > 5yrs after the first dose Child >2yrs: Same as adult dose Elderly >50 yrs: Who have not received vaccine within 5 yrs (and were <50 yrs of age at the time of vaccination) should receive another dose of vaccine

Precautions: severe cardiovascular or pulmonary disease, acute febrile respiratory illness or other active infection delays the immunization, vaccines should be given at least 2 wks before starting immunosuppressive therapy

ADR: Serious: Guillain-Barre syndrome, seizure, radiculoneuropathy, lymphadenitis, lymphadenopathy, hemolytic anemia, thrombocytopenia, anaphylactoid reactions, serum sickness, angioneurotic edema, arthralgia, arthritis, myalgia, paresthesia, Others: headache, injection site erythema, induration, swelling, peripheral edema in injected extremity, nausea, vomiting, rash, urticaria, fever, headache, pain, malaise, chills

DDI: Serious Immunosuppressants decreases pneumococcal vaccine effects, Vaccine Zoster effects are decreased by pneumococcal vaccine

Monitor: