Prevnar 20 (PCV20) Recommendations for Adults
All adults aged ≥50 years who have never received a pneumococcal conjugate vaccine should receive a single dose of Prevnar 20 (PCV20). 1
Primary Vaccination Recommendations
Age-Based Recommendations
- Adults aged ≥50 years who are pneumococcal vaccine-naïve should receive one dose of PCV20 2, 1
- Adults aged 19-49 years with chronic medical conditions (chronic heart disease, chronic lung disease, chronic liver disease, diabetes mellitus) or who are current smokers should receive PCV20 3
- Adults aged 19-49 years with immunocompromising conditions (HIV infection, immunodeficiencies, iatrogenic immunosuppression, malignancy, sickle cell disease, solid organ transplant) should receive PCV20 3
Vaccine Options
- PCV20 (Prevnar 20) can be given as a single dose alone, which completes the pneumococcal vaccination series 2, 3
- Alternative options include PCV15 followed by PPSV23, or PCV21 (CAPVAXIVE), though PCV20 remains a preferred option 2
Previously Vaccinated Adults
For Adults Who Received PPSV23 Only
- Administer one dose of PCV20 at least 1 year after the last PPSV23 dose 3, 4
- This applies to all adults aged ≥50 years, including those with chronic conditions like diabetes 3
For Adults Who Received PCV13 Only
- Administer one dose of PCV20 at least 1 year after the PCV13 dose 3, 4
- For immunocompromised adults, this interval can be as short as 1 year 3
For Adults Who Received Both PCV13 and PPSV23
- Shared clinical decision-making is recommended regarding administration of PCV20 3
- If given, PCV20 should be administered ≥5 years after the last pneumococcal vaccine dose 3
- This applies particularly to adults who completed the series with PPSV23 at age ≥65 years 3
Clinical Indications and Coverage
Disease Prevention
- PCV20 provides active immunization against invasive pneumococcal disease caused by 20 serotypes (1,3,4,5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, 33F) 4
- PCV20 prevents pneumonia caused by all 20 vaccine serotypes in adults aged ≥18 years 4
- The vaccine adds 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F, 33F) beyond the original PCV13 formulation 2, 5
High-Risk Populations
- Current smokers have 2.8-4.1 times the risk for invasive pneumococcal disease and should receive PCV20 3
- Adults with cardiovascular disease benefit from pneumococcal vaccination, with studies showing a 22% reduction in all-cause mortality 3
- Immunocompromised adults can receive PCV20 with a shortened interval of 8 weeks between PCV15 and PPSV23 if using the sequential regimen 3
Key Implementation Points
Completion of Vaccination Series
- After PCV20 administration, no additional pneumococcal vaccines are needed in most scenarios 3
- This simplifies vaccination compared to sequential PCV13/PPSV23 regimens 3
- Once PCV20 is administered, the pneumococcal vaccination series is complete for most patients 3
Safety Profile
- Most common adverse reactions in adults aged 18-59 years include injection site pain (>70%), muscle pain (>50%), fatigue (>40%), headache (>30%) 4
- In adults aged ≥60 years, common reactions include injection site pain (>50%), muscle pain and fatigue (>30%), headache (>20%) 4
- Post-licensure surveillance identified a data mining alert for Guillain-Barré syndrome (0.5 cases per million doses), which is under investigation 6
Administration
- PCV20 is administered as a 0.5 mL intramuscular injection 4
- The vaccine is supplied in a single-dose pre-filled syringe 4
Common Pitfalls to Avoid
- Do not administer additional pneumococcal vaccines after PCV20 completion 3
- Ensure minimum intervals are met: at least 1 year after PPSV23 or PCV13, and at least 5 years for those who received both PCV13 and PPSV23 3
- Do not confuse PCV20 with the newer PCV21 (CAPVAXIVE), which contains different serotypes and was licensed in 2024 2
- Contraindication: Do not administer to individuals with severe allergic reaction to any component of PCV20 or diphtheria toxoid 4