Is Pneumococcal Conjugate Vaccine 20 (PCV 20) alone adequate for protection against pneumococcal disease or should I also receive Pneumococcal Polysaccharide Vaccine 23 (PPSV23)?

PCV20 Alone Is Adequate for Most Adults Without Need for Additional PPSV23

According to the most recent 2024 Advisory Committee on Immunization Practices (ACIP) guidelines, PCV20 alone is adequate for protection against pneumococcal disease without the need for additional PPSV23 vaccination. 1

Current Recommendations

• If you receive PCV20 (or the newer PCV21), no additional pneumococcal vaccination with PPSV23 is needed, as stated in the 2024 ACIP guidelines 1
• The ACIP specifically notes: "If PCV21 or PCV20 is used in place of any dose of PPSV23, the series is complete, and it need not be followed by additional pneumococcal vaccine doses" 1
• PCV20 provides protection against 20 pneumococcal serotypes, which includes the majority of disease-causing strains 2

Rationale for PCV20 Alone Being Sufficient

• Conjugate vaccines like PCV20 induce a T-cell dependent immune response that creates memory B-cells, providing more durable protection compared to polysaccharide vaccines like PPSV23 3
• Clinical trials have demonstrated that PCV20 generates robust immune responses to all 20 vaccine serotypes across different age groups 4
• PCV20 was specifically developed to expand protection beyond earlier pneumococcal vaccines and has been shown to be immunogenic even in adults who previously received other pneumococcal vaccines 5

Special Considerations Based on Vaccination History

If you have already received other pneumococcal vaccines:

• If you previously received PPSV23 only: A single dose of PCV20 is recommended ≥1 year after the last PPSV23 dose, with no need for additional PPSV23 1
• If you previously received PCV13 only: A single dose of PCV20 is recommended ≥1 year after the PCV13 dose, with no need for additional PPSV23 1
• If you previously received both PCV13 and PPSV23: The series is considered complete, but shared clinical decision-making regarding an additional dose of PCV20 may be considered ≥5 years after the last pneumococcal vaccine dose 6

Potential Benefits of PCV20 vs. PPSV23

• PCV20 contains 20 serotypes that cause the majority of invasive pneumococcal disease, providing broad coverage 2
• Conjugate vaccines like PCV20 generally induce stronger and more durable immune responses than polysaccharide vaccines like PPSV23 3
• PCV20 has been shown to be safe and immunogenic in adults across different age groups and with different prior pneumococcal vaccination histories 5, 7

Common Pitfalls to Avoid

• Unnecessary revaccination with PPSV23 after PCV20 is not recommended and provides no additional benefit according to current guidelines 1
• Waiting too long between vaccines if you are following a sequential vaccination schedule (for example, if using PCV15 followed by PPSV23) 1
• Failing to consider your specific risk factors and vaccination history when determining the appropriate pneumococcal vaccination strategy 6

In conclusion, based on the most recent 2024 ACIP guidelines, PCV20 alone provides adequate protection against pneumococcal disease without the need for additional PPSV23 vaccination. This simplifies the pneumococcal vaccination schedule and provides broad coverage against the most common disease-causing serotypes.