Pneumococcal Vaccination Strategy: PCV20 vs PCV13
For adults requiring pneumococcal vaccination, PCV20 (Prevnar 20) is recommended over PCV13 (Prevnar 13) as it provides broader serotype coverage in a single dose, eliminating the need for sequential vaccination in most cases. 1, 2
Current Pneumococcal Vaccine Options
- Four pneumococcal vaccines are currently licensed for use in adults in the United States: 23-valent pneumococcal polysaccharide vaccine (PPSV23), 13-valent pneumococcal conjugate vaccine (PCV13), 15-valent pneumococcal conjugate vaccine (PCV15), 20-valent pneumococcal conjugate vaccine (PCV20), and the newly approved 21-valent pneumococcal conjugate vaccine (PCV21) 1
- PCV20 contains all 13 serotypes in PCV13 plus 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F), providing broader protection against pneumococcal disease 2, 3
- The Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal conjugate vaccines for all adults aged ≥65 years and adults aged 19-64 years with certain risk conditions 1, 2
Advantages of PCV20 over PCV13
- PCV20 eliminates the need for sequential vaccination with PPSV23 in most cases, simplifying the vaccination schedule with a single dose approach 1, 2
- PCV20 provides protection against 7 additional serotypes not covered by PCV13, which are responsible for significant pneumococcal disease burden 3
- Clinical trials have demonstrated that PCV20 induces robust immune responses to all 20 serotypes covered by the vaccine 3
- PCV20 has a safety and tolerability profile similar to that of PCV13 4, 3
Specific Recommendations by Patient Group
For Adults ≥65 Years of Age:
- For pneumococcal vaccine-naïve adults or those with unknown vaccination history: A single dose of PCV20 is recommended 1, 2
- For adults previously vaccinated with PPSV23 only: A single dose of PCV20 is recommended at least 1 year after the last PPSV23 dose 2
- For adults previously vaccinated with PCV13 only: A single dose of PCV20 is recommended at least 1 year after the PCV13 dose 2
For Adults 19-64 Years with Risk Conditions:
- For adults with immunocompromising conditions, cerebrospinal fluid leaks, or cochlear implants: A single dose of PCV20 is recommended 1
- For adults with chronic medical conditions (e.g., heart disease, lung disease, diabetes): A single dose of PCV20 is recommended 1, 2
Important Clinical Considerations
- When administering pneumococcal vaccines, the intramuscular route is preferred for PCV20 1
- Potential adverse reactions include injection site reactions (pain, redness, swelling), fatigue, muscle pain, headache, and joint pain, which are generally mild to moderate in severity 4
- The rates of serious adverse events following PCV20 vaccination are low and similar to those observed with PCV13 4, 3
- Individuals with impaired immune responsiveness due to immunosuppressive therapy may not respond optimally to PCV20 4
Recent Developments
- In 2024, the FDA approved PCV21 (CAPVAXIVE) for use in adults aged ≥18 years, which contains eight serotypes not included in other licensed vaccines 1
- The ACIP has expanded age-based recommendations to include all adults aged ≥50 years for pneumococcal conjugate vaccination 5
- For adults who have already received PCV13, completing the series with PCV20 is recommended rather than starting over with a new vaccination series 2
Common Pitfalls to Avoid
- Failing to check vaccination history before administering pneumococcal vaccines, which could lead to unnecessary revaccination 1, 2
- Not allowing sufficient intervals between different pneumococcal vaccines (at least 1 year after PPSV23 or PCV13 before administering PCV20) 2
- Overlooking the need for pneumococcal vaccination in adults with certain chronic medical conditions who are younger than 65 years 1
By choosing PCV20 over PCV13, clinicians can provide broader serotype coverage with a simplified vaccination schedule, potentially improving patient compliance and protection against pneumococcal disease.