Do I need Prevnar 20 (Pneumococcal conjugate vaccine) if I've already received Prevnar 13 (Pneumococcal conjugate vaccine) and Pneumovax 23 (Pneumococcal polysaccharide vaccine)?

Pneumococcal Vaccination After Prevnar 13 and Pneumovax 23

If you've already received both Prevnar 13 and Pneumovax 23, you generally do not need Prevnar 20 unless you are 65 years or older, in which case shared clinical decision-making is recommended with your healthcare provider regarding administration of PCV20 at least 5 years after your last pneumococcal vaccine dose.

Current Recommendations Based on Prior Vaccination History

For Adults Who Have Received Both PCV13 and PPSV23

• For adults who have completed their recommended pneumococcal vaccine series with both PCV13 and PPSV23 (with PPSV23 administered at age ≥65 years), shared clinical decision-making is recommended regarding administration of PCV20 1
• If a decision to administer PCV20 is made, a single dose should be given at least 5 years after the last pneumococcal vaccine dose 1
• This recommendation is based on clinical trial data showing that PCV20 is safe and immunogenic in adults who previously received both PCV13 and PPSV23 2

Factors to Consider in Shared Decision-Making

• Patient's risk for pneumococcal disease: Underlying medical conditions that increase risk 1
• Time since last pneumococcal vaccination: Longer intervals may warrant consideration of PCV20 1
• Risk of exposure to pneumococcal serotypes: PCV20 contains additional serotypes not in PCV13 or PPSV23 1
• Immune response considerations: Receipt of PPSV23 1-5 years prior to PCV20 resulted in diminished immune responses compared to those who received PCV13 followed by PPSV23 3

Scientific Rationale

• PCV20 contains all 13 serotypes in PCV13 plus 7 additional serotypes, potentially providing broader protection 4
• Conjugate vaccines (like PCV20) induce a T-cell dependent response, creating memory B-cells, while polysaccharide vaccines (PPSV23) induce a T-cell independent response without memory B-cell creation 1
• Phase III clinical trials demonstrated that PCV20 is safe and immunogenic in adults ≥65 years who previously received both PCV13 and PPSV23 2
• Economic models showed variable cost-effectiveness for additional PCV20 vaccination after complete series, ranging from $93,000 to $970,000 per QALY gained 1

Special Considerations

For Immunocompromised Individuals

• Adults with immunocompromising conditions who have received both PCV13 and PPSV23 may benefit from PCV20 administered ≥5 years after the last pneumococcal vaccine dose 1
• Economic models for immunocompromised adults showed variable results, from $40,000 per QALY gained to potentially worse health outcomes 1

For Adults with Chronic Medical Conditions

• The NCCN Guidelines for cancer patients recommend PCV20 for those who are pneumococcal vaccine-naïve 1
• For those with prior vaccination history, follow the same recommendations as the general population based on previous vaccine receipt 1

Potential Benefits and Limitations

Benefits of Additional PCV20 Vaccination

• Provides protection against 7 additional serotypes not covered in PCV13 4
• Conjugate vaccines like PCV20 may provide better and longer-lasting protection than polysaccharide vaccines 5

Limitations and Considerations

• Immune responses to PCV20 may be diminished if PPSV23 was received 1-5 years prior 3
• The cost-effectiveness of additional vaccination varies significantly based on time since previous vaccination and individual risk factors 1

Conclusion

For most adults who have already received both Prevnar 13 and Pneumovax 23, routine administration of Prevnar 20 is not currently recommended. However, for adults aged ≥65 years, shared clinical decision-making is appropriate, considering individual risk factors, time since last vaccination, and potential benefits of broader serotype coverage.