Which pneumococcal conjugate vaccine (PCV), PCV 15 (Pneumococcal Conjugate Vaccine 15) or PCV 20 (Pneumococcal Conjugate Vaccine 20), is recommended for a 2-month-old infant?

Pneumococcal Conjugate Vaccine Recommendations for 2-Month-Old Infants

Either PCV15 or PCV20 can be used for a 2-month-old infant starting their pneumococcal vaccination series, as both are recommended by the CDC for the infant vaccination schedule. 1

Infant Pneumococcal Vaccination Schedule

The pneumococcal vaccination schedule for infants consists of:

• A 4-dose series administered at:
  • 2 months (first dose)
  • 4 months (second dose)
  • 6 months (third dose)
  • 12-15 months (fourth/booster dose) 1

Comparing PCV15 and PCV20

PCV15

• Covers 15 pneumococcal serotypes (includes the 13 serotypes in PCV13 plus serotypes 22F and 33F) 2
• FDA-approved for individuals ≥6 weeks of age 2
• Demonstrated superior immunogenicity for serotype 3 compared to previous PCV13 2, 3
• Safety profile comparable to PCV13 in clinical trials 3

PCV20

• Covers 20 pneumococcal serotypes (adds 7 additional serotypes beyond PCV13) 4
• Has shown acceptable safety profile in infant studies 4
• Likely to supplant the previous two-dose strategy (conjugate vaccine followed by polysaccharide vaccine) in adults 5
• May provide broader protection against non-vaccine serotypes that have increased in prevalence 4

Clinical Considerations

• Both vaccines have demonstrated acceptable safety profiles in infant studies 3, 4
• The CDC recommends starting the pneumococcal vaccination series at 2 months of age 1
• For premature infants who are medically stable, pneumococcal conjugate vaccine should be administered at the recommended chronologic age along with other routine vaccinations 1

Special Populations

For infants with certain medical conditions, such as sickle cell disease, additional considerations apply:

• The 2023 recommendations of the Advisory Committee on Immunization Practices support using either PCV15 or PCV20 for children with sickle cell disease 5
• For children with immunocompromising conditions, additional pneumococcal vaccination may be recommended after completing the initial PCV series 1

Important Caveats

• The pneumococcal conjugate vaccine can be administered concurrently with other routine childhood vaccines at different injection sites 1
• If doses are missed, the vaccination schedule should be continued without restarting the entire series 1
• PCV20 is relatively newer in pediatric populations, but studies have shown promising safety and immunogenicity results 4

While both vaccines are acceptable options, the broader serotype coverage of PCV20 may provide additional protection against emerging serotypes, though PCV15 has more established data in pediatric populations. The decision should be made based on vaccine availability and local epidemiological considerations of pneumococcal serotypes.