PCV20 Vaccination: No Additional Pneumococcal Vaccines Required
If a patient has received PCV20, no additional pneumococcal vaccination is needed—the series is complete. 1
Key Principle
PCV20 is a standalone vaccine that provides comprehensive pneumococcal coverage and does not require follow-up with PPSV23 or any other pneumococcal vaccine. 2, 3 This represents a significant simplification compared to older vaccination strategies that required sequential dosing.
Why No Additional Vaccination Is Needed
- PCV20 contains 20 pneumococcal serotypes, including all 13 serotypes from PCV13 plus 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F). 4
- The vaccine provides both conjugate vaccine benefits and broad serotype coverage, eliminating the historical need for PPSV23 supplementation. 2, 3
- ACIP explicitly states that when PCV20 is used, the pneumococcal vaccination series is complete and need not be followed by additional doses. 1
Special Populations and Exceptions
Hematopoietic Stem Cell Transplant (HSCT) Recipients
The only exception to the single-dose rule is for HSCT recipients, who require a 4-dose PCV20 series: 1
- 3 doses given 4 weeks apart, starting 3-6 months after HSCT
- Fourth dose given ≥6 months after the third dose OR ≥12 months after HSCT, whichever is later
Patients Who Previously Completed PCV13 + PPSV23
For adults ≥65 years who already received both PCV13 and PPSV23 (with PPSV23 given at age ≥65): 1
- Shared clinical decision-making may be used to consider an additional dose of PCV20
- If given, must wait ≥5 years since the last PCV13 or PPSV23 dose
- This is optional, not required—the patient is already considered adequately vaccinated
Common Pitfalls to Avoid
- Do not reflexively add PPSV23 after PCV20. Unlike PCV15, which requires PPSV23 follow-up, PCV20 stands alone. 1, 2
- Do not confuse PCV20 with PCV15. PCV15 requires PPSV23 at ≥1 year (or ≥8 weeks for immunocompromised patients), but PCV20 does not. 1
- Do not revaccinate unnecessarily. Once PCV20 is given, additional pneumococcal vaccines are generally not indicated unless the patient is an HSCT recipient. 1, 3
Clinical Context
The introduction of PCV20 (and PCV21, approved in 2024) has dramatically simplified pneumococcal vaccination by eliminating the need for sequential vaccination strategies in most patients. 1, 5 Studies demonstrate that PCV20 is well-tolerated and immunogenic regardless of prior pneumococcal vaccination history, including in patients previously vaccinated with PPSV23, PCV13, or both. 6
Documentation Recommendation
When documenting PCV20 administration, note that the pneumococcal vaccination series is complete to prevent future providers from inappropriately adding PPSV23. 2, 3