What is the recommended dosing schedule for Prevnar 20 (Pneumococcal conjugate vaccine)?

Prevnar 20 Dosing Recommendations

For adults ≥18 years of age, Prevnar 20 is administered as a single 0.5 mL intramuscular dose. 1

Adult Dosing (≥18 Years)

Vaccine-Naïve Adults

• Adults ≥65 years: Administer one dose of PCV20 alone 2
• Adults 19-64 years with chronic medical conditions (diabetes, heart disease, lung disease, liver disease, smoking): Administer one dose of PCV20 alone 2
• Adults 19-64 years with immunocompromising conditions (HIV, malignancy, immunosuppression, asplenia, CSF leak, cochlear implant): Administer one dose of PCV20 alone 2

Previously Vaccinated Adults

If received PPSV23 only:

• Administer one dose of PCV20 ≥1 year after the last PPSV23 dose 2, 3

If received PCV13 only:

• Administer one dose of PCV20 ≥1 year after the PCV13 dose 2, 3
• For immunocompromised adults, this interval can be as short as ≥1 year 2

If received both PCV13 and PPSV23:

• For adults who completed the series with PPSV23 at age ≥65 years: Shared clinical decision-making regarding a single dose of PCV20 ≥5 years after the last pneumococcal vaccine dose 2, 3
• For adults 19-64 years with immunocompromising conditions who received PCV13 and 1 dose of PPSV23: Administer PCV20 ≥5 years after the last pneumococcal vaccine dose 2

Pediatric Dosing (6 Weeks Through 17 Years)

Routine Infant Series (6 Weeks Through 15 Months)

• Four-dose series: Administer at 2,4,6, and 12-15 months of age 1
• First dose may be given as early as 6 weeks of age 1
• Fourth dose must be given at least 2 months after the third dose 1

Catch-Up Schedule for Unvaccinated Children

Ages 7-11 months:

• Three doses total: First 2 doses at least 4 weeks apart; third dose after the first birthday, separated from the second dose by at least 2 months 1

Ages 12-23 months:

• Two doses at least 2 months apart 1

Ages 24 months through 17 years:

• Single dose 1

Previously Vaccinated with Lower Valency PCV

• For children 15 months through 17 years previously vaccinated with a lower valency pneumococcal conjugate vaccine: Administer a single dose of Prevnar 20 ≥8 weeks after the last dose of the lower valency vaccine 1

Administration Details

• Route: Intramuscular injection only 1
• Dose volume: 0.5 mL per dose 1
• Preparation: Shake vigorously until homogeneous white suspension is achieved 1
• Do not mix with other vaccines in the same syringe 1

Key Clinical Considerations

After PCV20 administration, no additional pneumococcal vaccines are needed in most scenarios, as PCV20 provides comprehensive coverage 2, 3. This represents a significant simplification compared to sequential PCV13/PPSV23 regimens.

Common Pitfalls to Avoid

• Interval errors: Immunocompromised adults need shorter intervals (≥8 weeks) between PCV15 and PPSV23, but when using PCV20, this complexity is eliminated as no PPSV23 is needed 2, 4
• Unnecessary revaccination: Once PCV20 is administered, the pneumococcal vaccination series is complete for most patients 2, 3
• Premature infants: Consider individual medical status when timing vaccination, as apnea has been observed following intramuscular vaccination in some premature infants 1