Indications for Prevnar 20 (Pneumococcal Conjugate Vaccine)
Prevnar 20 is indicated for active immunization to prevent invasive pneumococcal disease caused by Streptococcus pneumoniae serotypes 1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older, as well as for prevention of pneumonia in adults 18 years and older. 1
FDA-Approved Indications
- Active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals 6 weeks of age and older 1
- Active immunization for the prevention of otitis media caused by S. pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F in individuals 6 weeks through 5 years of age 1
- Active immunization for the prevention of pneumonia caused by the 20 included serotypes in individuals 18 years of age and older 1
Recommended Adult Populations
Age-Based Recommendations
Risk-Based Recommendations (Ages 19-64)
Adults with the following conditions:
- Chronic heart disease (including congestive heart failure and cardiovascular diseases) 2
- Chronic lung disease 2
- Chronic liver disease 2
- Diabetes mellitus 2, 4
- Cigarette smoking 2
- Alcoholism 2
- Chronic renal failure 2
- Cochlear implant 2
- Cerebrospinal fluid (CSF) leak 2
- Congenital or acquired asplenia 2
- Sickle cell disease or other hemoglobinopathies 2
- Immunocompromising conditions: 2
Vaccination Schedule
Adults (18 years and older)
- Administered as a single 0.5 mL dose 1
- For adults who have never received a pneumococcal conjugate vaccine: one dose of PCV20 alone 2
- For adults who previously received PPSV23 only: one dose of PCV20 at least 1 year after the last PPSV23 dose 2
- For adults who previously received PCV13 only: one dose of PCV20 at least 1 year after the PCV13 dose 2
- For adults who received both PCV13 and PPSV23: shared clinical decision-making is recommended regarding administration of PCV20, which if given should be administered ≥5 years after the last pneumococcal vaccine dose 2
Children (6 weeks through 17 years)
- Administered as a 4-dose series at 2,4,6, and 12-15 months of age 1
Clinical Efficacy and Safety
- PCV20 demonstrated robust immune responses for all 20 serotypes included in the vaccine, with geometric mean fold rises from baseline ranging from 6.0 to 113.4 in adults 60-64 years of age 5
- In pivotal Phase 3 trials, PCV20 was safe and well tolerated, with immunogenicity comparable to that of PCV13 or PPSV23 6
- The most common adverse reactions in adults 18-59 years include injection site pain (>70%), muscle pain (>50%), fatigue (>40%), headache (>30%), and arthralgia and injection site swelling (>10%) 1
- In adults ≥60 years, common adverse reactions include injection site pain (>50%), muscle pain and fatigue (>30%), headache (>20%), and arthralgia (>10%) 1
Special Considerations
- For immunocompromised adults, the minimum interval between PCV15 and PPSV23 can be shortened to 8 weeks (rather than the standard 1-year interval) 2
- Pneumococcal vaccination has been associated with a 22% reduction in all-cause mortality among adults with cardiovascular disease or very high cardiovascular risk 2
- Current smokers have 2.8-4.1 times the risk for invasive pneumococcal disease compared with adults without underlying risk conditions 2
Common Pitfalls to Avoid
- After receiving PCV20, no additional pneumococcal vaccines are needed 2, 4
- Ensure at least 1 year has passed since the last PPSV23 dose before administering PCV20 2, 4
- Do not confuse the different pneumococcal vaccines (PCV20, PCV15, PCV13, PPSV23) and their specific indications and schedules 2
- Remember that adults with multiple risk factors have higher residual disease burden and may benefit more from vaccination 2