Administration of PCV20 After PPSV23
Yes, PCV20 can and should be administered to adults who have previously received PPSV23, with a minimum interval of 1 year between the PPSV23 dose and the PCV20 dose. 1
Rationale and Recommendations
The 2023 Advisory Committee on Immunization Practices (ACIP) guidelines provide clear recommendations for pneumococcal vaccination in adults who have previously received PPSV23:
- Adults who have received PPSV23 only should receive a single dose of either PCV20 or PCV15 at least 1 year after the last PPSV23 dose 1
- When PCV20 is used in adults who previously received PPSV23, no additional doses of PPSV23 are needed 1
This recommendation applies to:
- Adults aged ≥65 years
- Adults aged 19-64 years with chronic medical conditions
- Adults aged 19-64 years with immunocompromising conditions, CSF leaks, or cochlear implants
Immunologic Advantages
PCV20 offers several advantages over PPSV23:
- Conjugate vaccines like PCV20 provide immunologic advantages compared to polysaccharide vaccines (PPSV23) 1
- PCVs induce stronger and potentially more durable immune responses 2
- PCV20 contains additional serotypes not included in PCV13, providing broader protection 2
Clinical Evidence
Phase III clinical studies support the safety and immunogenicity of PCV20 in adults who previously received PPSV23:
- A phase 3 trial demonstrated that PCV20 was well tolerated and immunogenic in adults ≥65 years previously vaccinated with different pneumococcal vaccine regimens, including PPSV23 3
- Robust immune responses to all 20 vaccine serotypes were observed 1 month after PCV20 administration regardless of prior pneumococcal vaccination history 3
Updated 2024 Guidance
The 2024 ACIP recommendations continue to support this approach and have expanded options to include the newer PCV21:
- Adults who previously received PPSV23 only should receive a single dose of PCV21, PCV20, or PCV15 at least 1 year after the last PPSV23 dose 1
Important Considerations
- Timing is critical: Maintain the minimum 1-year interval between PPSV23 and subsequent PCV20 to ensure optimal immune response 1
- Documentation: Verify the patient's vaccination history to confirm previous PPSV23 administration
- No additional doses needed: When PCV20 is used after PPSV23, the pneumococcal vaccination series is considered complete 1
- Broader protection: PCV20 provides protection against 7 additional serotypes not contained in PCV13 4
Special Populations
For adults with immunocompromising conditions who received PPSV23 only:
- A single dose of PCV20 is recommended at least 1 year after the last PPSV23 dose 1
- This approach provides broader serotype coverage and the immunologic advantages of conjugate vaccines 1
By following these recommendations, clinicians can ensure optimal protection against pneumococcal disease while adhering to evidence-based vaccination schedules.