What is the indication for Prevnar 20 (Pneumococcal conjugate vaccine)

Indications for Prevnar 20 (Pneumococcal Conjugate Vaccine)

Prevnar 20 is indicated for active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older, as well as for the prevention of pneumonia in adults 18 years and older, and otitis media in children 6 weeks through 5 years of age. 1

Specific Indications by Age Group

Children (6 weeks to 17 years)

• Prevention of invasive pneumococcal disease (IPD) caused by all 20 serotypes included in the vaccine 1, 2
• Prevention of otitis media caused by serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F in children 6 weeks through 5 years of age 1, 2

Adults (18 years and older)

• Prevention of invasive pneumococcal disease caused by all 20 serotypes included in the vaccine 1
• Prevention of pneumonia caused by all 20 serotypes in the vaccine 1
  • Note: The indication for prevention of pneumonia caused by serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F was approved under accelerated approval based on immune responses measured by opsonophagocytic activity (OPA) assay 1

Recommended Population Groups

Adults

1. All adults aged ≥50 years should receive a single dose of PCV20 3
2. Adults 19-64 years with underlying medical conditions:
   • Chronic heart, lung, or liver disease
   • Diabetes mellitus
   • Alcoholism
   • Cigarette smoking
   • Cerebrospinal fluid leaks
   • Cochlear implants 4
3. Immunocompromised adults 19-64 years:
   • Asplenia (functional or anatomic)
   • Sickle cell disease
   • HIV infection
   • Other immunocompromising conditions 4

Children

• Recommended as a 4-dose immunization series at 2,4,6, and 12 through 15 months of age 1

Vaccination Schedule

Children

• 4-dose series at 2,4,6, and 12-15 months of age 1

Adults

• Single dose for adults 18 years and older 1
• For adults previously vaccinated with PCV13, a single dose of PCV20 can be administered 3
• For immunocompromised patients who received PPSV23, revaccination after 5 years should be considered 4

Clinical Benefits

Prevnar 20 provides expanded serotype coverage compared to earlier pneumococcal conjugate vaccines, including the seven additional serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F) not contained in PCV13 5. These additional serotypes cause approximately 20-30% of invasive pneumococcal disease cases among adults with indications for vaccination 6.

The conjugate vaccine technology in PCV20 offers immunologic advantages over the polysaccharide vaccine (PPSV23), including:

• Better immune memory
• Longer-lasting protection
• More robust immune response in both children and adults 4

Common Adverse Reactions

In children

• Irritability (>60%)
• Pain at injection site (>30%)
• Drowsiness (>30%)
• Decreased appetite and injection site redness (>20%)
• Injection site swelling (>10%)
• Fever (>10%) 1

In adults 18-59 years

• Pain at injection site (>70%)
• Muscle pain (>50%)
• Fatigue (>40%)
• Headache (>30%)
• Arthralgia and injection site swelling (>10%) 1

In adults ≥60 years

• Pain at injection site (>50%)
• Muscle pain and fatigue (>30%)
• Headache (>20%)
• Arthralgia (>10%) 1

Special Considerations

• Apnea following vaccination has been observed in premature infants; decisions about vaccination timing should consider the individual infant's medical status 1
• Prevnar 20 can be administered with other age-appropriate vaccines at the same visit if there are no specific contraindications 4
• Contraindicated in individuals with severe allergic reaction to any component of Prevnar 20 or to diphtheria toxoid 1

By expanding coverage to include 20 pneumococcal serotypes, Prevnar 20 represents a significant advancement in pneumococcal disease prevention, with potential to further reduce morbidity and mortality from these infections across all age groups.