PCV-20 Vaccination Recommendations for Adults
All adults aged 65 years and older should receive a single dose of PCV-20 vaccine, as well as adults aged 19-64 years with certain underlying medical conditions or risk factors who have not previously received a pneumococcal conjugate vaccine. 1
Who Should Receive PCV-20 Vaccine
Age-Based Recommendations
- Adults aged ≥65 years: All should receive a single dose of PCV-20 regardless of medical conditions or previous pneumococcal vaccination history (except those who have completed both PCV13 and PPSV23 series)
Risk-Based Recommendations (Adults 19-64 years)
Adults with the following conditions should receive PCV-20:
Chronic medical conditions:
- Alcoholism
- Chronic heart disease (including congestive heart failure and cardiomyopathies)
- Chronic liver disease
- Chronic lung disease (including COPD, emphysema, and asthma)
- Cigarette smoking
- Diabetes mellitus
Immunocompromising conditions:
- Chronic renal failure
- Nephrotic syndrome
- Immunodeficiency
- Iatrogenic immunosuppression
- Generalized malignancy
- HIV infection
- Hodgkin disease
- Leukemia, lymphoma, multiple myeloma
- Solid organ transplant
- Congenital or acquired asplenia
- Sickle cell disease or other hemoglobinopathies
Other high-risk conditions:
- Cerebrospinal fluid (CSF) leak
- Cochlear implant
Vaccination Schedule Based on Prior Pneumococcal Vaccination History
For Adults with No Previous Pneumococcal Vaccination
- Administer a single dose of PCV-20 alone 1
- Alternative: Administer PCV-15 followed by PPSV23 ≥1 year later (≥8 weeks later for immunocompromised patients)
For Adults Previously Vaccinated with PPSV23 Only
- Administer a single dose of PCV-20 after a ≥1 year interval since the last PPSV23 dose 1
For Adults Previously Vaccinated with PCV13 Only
- Administer a single dose of PCV-20 after a ≥1 year interval since the PCV13 dose 1
For Adults Who Completed Both PCV13 and PPSV23 Series
- No routine recommendation for additional vaccination
- Shared clinical decision-making is recommended regarding PCV-20 administration for adults ≥65 years who completed both PCV13 and PPSV23 series 1
- If decision to administer PCV-20 is made, give a single dose ≥5 years after the last pneumococcal vaccine
Special Population: Hematopoietic Stem Cell Transplant Recipients
- Administer 3 doses of PCV-20,4 weeks apart starting 3-6 months after transplant
- Administer a fourth PCV-20 dose ≥6 months after the third dose or ≥12 months after transplant, whichever is later 1
Clinical Considerations for Shared Decision-Making
When considering PCV-20 for adults who completed PCV13 and PPSV23 series, evaluate:
- Patient's risk for pneumococcal disease due to underlying conditions
- Time elapsed since last pneumococcal vaccination (benefit increases if ≥5 years)
- Presence of multiple chronic conditions that increase disease risk
- Immunocompromising conditions that maintain higher residual disease burden 1
Implementation Pitfalls and Caveats
- Vaccination history verification: Always verify previous pneumococcal vaccination history before administering PCV-20 2
- Interval timing: Respect minimum intervals between different pneumococcal vaccines to ensure optimal immune response 1
- Documentation requirements: Document site of injection, lot number, and expiration date for proper reimbursement 2
- Risk assessment: The risk for pneumococcal disease increases with multiple chronic conditions - patients with more than one condition may benefit most from vaccination 1
- Cigarette smoking: Current smokers have 2.8-4.1 times higher risk for invasive pneumococcal disease compared to adults without risk factors 1
- Chronic heart disease: Patients with chronic heart disease have up to 3.3 times higher odds for community-acquired pneumonia and 9.9 times higher odds for invasive pneumococcal disease 1
The 2023 ACIP recommendations significantly simplified the previous complex pneumococcal vaccination schedule, making PCV-20 a straightforward option that provides broad serotype coverage with a single dose for most adults 3.