Is the Pneumococcal Conjugate Vaccine 20 (PCV20) or Pneumococcal Conjugate Vaccine 23 (PCV23) better?

PCV20 is Superior to PPSV23 for Pneumococcal Vaccination in Adults

PCV20 (Pneumococcal Conjugate Vaccine 20) is superior to PPSV23 (Pneumococcal Polysaccharide Vaccine 23) due to its enhanced immunologic advantages and broader serotype coverage, making it the preferred choice for pneumococcal vaccination in adults. 1

Advantages of PCV20 over PPSV23

• Immunologic Superiority: PCVs (including PCV20) have demonstrated immunologic advantages compared to PPSV23, including:

  • More robust and longer-lasting immune response
  • Better memory B-cell response
  • Enhanced protection against both invasive and non-invasive pneumococcal disease 1

• Simplified Administration: PCV20 requires only a single dose, while previous recommendations often required sequential administration of different pneumococcal vaccines 2

• Comprehensive Coverage: PCV20 provides protection against 20 pneumococcal serotypes that cause the majority of pneumococcal disease 1

Clinical Evidence Supporting PCV20

Phase III clinical trials have demonstrated that PCV20 is:

• Safe and well-tolerated in adults across different age groups 3, 4
• Immunogenic regardless of prior pneumococcal vaccination history 3
• Non-inferior to PCV13 for the 13 matched serotypes and to PPSV23 for 6 of 7 additional serotypes 5

A recent study in adults ≥65 years with prior pneumococcal vaccination showed robust immune responses to all 20 vaccine serotypes after PCV20 administration, regardless of previous vaccination with PPSV23, PCV13, or both 3.

Current Recommendations

The CDC Advisory Committee on Immunization Practices (ACIP) recommends:

1. For pneumococcal vaccine-naïve adults: A single dose of PCV20 alone 1, 2

2. For adults who previously received PPSV23 only: A single dose of PCV20 ≥1 year after the last PPSV23 dose 1

3. For adults who previously received PCV13 only: Either PCV20 ≥1 year after PCV13 or PPSV23 (with appropriate intervals) 1

4. For adults who received both PCV13 and PPSV23 but haven't completed their series: Either PCV20 ≥5 years after the last pneumococcal vaccine dose or PPSV23 with appropriate intervals 1

Economic Considerations

PCV20 has been shown to be cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164 in one European study. Compared to the sequential regimen of PCV15+PPSV23, PCV20 vaccination was found to be a cost-saving strategy 6.

Special Populations

For adults with immunocompromising conditions (chronic renal failure, nephrotic syndrome, immunodeficiency, etc.), CSF leaks, or cochlear implants:

• If previously received PCV13 only: PCV20 is recommended ≥1 year after PCV13 1
• If previously received both PCV13 and PPSV23: PCV20 is recommended ≥5 years after the last pneumococcal vaccine 1

Potential Pitfalls and Caveats

• While PPSV23 technically covers 3 additional serotypes compared to PCV20, the immunologic advantages of PCV20 outweigh this theoretical benefit 1
• For serotype 8, PCV20 narrowly missed the statistical non-inferiority criterion compared to PPSV23 in some studies, but secondary endpoints still showed robust immune responses 5
• Proper timing between different pneumococcal vaccines is essential for optimal immune response 2

Conclusion

Based on the most recent evidence and guidelines, PCV20 is superior to PPSV23 for pneumococcal vaccination in adults due to its enhanced immunogenicity, simplified administration schedule, and comprehensive serotype coverage that addresses the most common disease-causing strains.