What are the recommendations for the Prevnar 20 (pneumococcal conjugate vaccine) vaccine?

Prevnar 20 (PCV20) Vaccination Recommendations

All adults aged ≥50 years should receive a single dose of PCV20 if they have never received a pneumococcal conjugate vaccine. 1, 2, 3

Primary Age-Based Recommendations

Adults ≥65 Years

• Administer one dose of PCV20 alone to all adults aged ≥65 years who are PCV-naïve 1, 2
• This represents the standard of care for pneumococcal disease prevention, which carries a case fatality ratio exceeding 10% in this population 1

Adults 50-64 Years

• Administer one dose of PCV20 to all adults aged 50-64 years who have never received a pneumococcal conjugate vaccine 3
• This expanded recommendation was adopted by ACIP in October 2024 to address the substantial disease burden in this age group 3

Adults 19-49 Years with Risk Conditions

• Administer one dose of PCV20 to adults aged 19-49 years with any of the following conditions who are PCV-naïve: 1, 2
  • Chronic heart disease (including congestive heart failure and cardiovascular diseases) 2
  • Chronic lung disease 2
  • Chronic liver disease 2
  • Diabetes mellitus 2
  • Current smoking (2.8-4.1 times increased risk for invasive pneumococcal disease) 2
  • Immunocompromising conditions (HIV infection, congenital or acquired immunodeficiencies, iatrogenic immunosuppression, generalized malignancy, Hodgkin disease, leukemia, lymphoma, multiple myeloma) 2
  • Sickle cell disease or other hemoglobinopathies 2
  • Solid organ transplant recipients 2

Catch-Up Vaccination for Previously Vaccinated Adults

Prior PPSV23 Only

• Administer one dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2
• This interval is critical to avoid potential immune interference 2
• After PCV20 administration, no additional pneumococcal vaccines are needed 2

Prior PCV13 Only

• Administer one dose of PCV20 at least 1 year after the PCV13 dose 1, 2
• For immunocompromised adults, this interval can be as short as 1 year 2
• PCV20 provides coverage for 7 additional serotypes beyond PCV13 1

Prior PCV13 and PPSV23

• Use shared clinical decision-making regarding administration of PCV20 2
• If administered, give PCV20 at least 5 years after the last pneumococcal vaccine dose 1, 2
• This scenario requires individualized assessment as the patient has already received substantial pneumococcal coverage 2

Administration Details

Dosing and Route

• Single 0.5 mL dose administered intramuscularly 4
• The vaccine must be shaken vigorously until it forms a homogeneous white suspension before administration 4
• Do not mix PCV20 with other vaccines in the same syringe 4

Special Populations

Immunocompromised Adults:

• Administer PCV20 on an individual basis, recognizing that immune responses may be reduced 4
• For those who received PCV13 and one dose of PPSV23, administer PCV20 at least 5 years after the last pneumococcal vaccine dose 2
• The minimum interval between PCV15 and PPSV23 can be shortened to 8 weeks in immunocompromised patients (though this applies to the PCV15/PPSV23 series, not PCV20) 2

Premature Infants:

• Consider the individual infant's medical status and weigh potential benefits against possible risks, as apnea has been observed following intramuscular vaccination in some premature infants 4

Key Clinical Advantages of PCV20

• Single-dose regimen eliminates the complexity of sequential vaccination (unlike PCV15 followed by PPSV23) 2
• Comprehensive serotype coverage includes all 13 serotypes from PCV13 plus 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F, 33F) 1, 4
• No additional pneumococcal vaccines needed after PCV20 in most clinical scenarios 2
• Conjugate vaccine technology provides T-cell dependent immune responses, offering superior and longer-lasting protection compared to polysaccharide vaccines 5

Safety Profile

Common Adverse Reactions in Adults 18-59 Years:

• Pain at injection site (>70%) 4
• Muscle pain (>50%) 4
• Fatigue (>40%) 4
• Headache (>30%) 4
• Arthralgia and injection site swelling (>10%) 4

Common Adverse Reactions in Adults ≥60 Years:

• Pain at injection site (>50%) 4
• Muscle pain and fatigue (>30%) 4
• Headache (>20%) 4
• Arthralgia (>10%) 4

Serious Considerations:

• Contraindicated in individuals with severe allergic reaction (anaphylaxis) to any component of PCV20 or diphtheria toxoid 4
• Appropriate medical treatment for managing immediate allergic reactions must be immediately available 4
• Safety and immunogenicity data are limited for immunocompromised groups 4

Clinical Outcomes

• Pneumococcal vaccination has been associated with a 22% reduction in all-cause mortality among adults with cardiovascular disease or very high cardiovascular risk 2
• PCV20 demonstrated robust immune responses including opsonophagocytic antibody responses to all 20 vaccine serotypes regardless of prior pneumococcal vaccination history 6
• The vaccine was well tolerated with safety profiles comparable to PCV13 across all age groups studied 6

Common Pitfalls to Avoid

• Do not administer PCV20 before the minimum interval has elapsed (1 year after PPSV23 or PCV13; 5 years after both PCV13 and PPSV23) 1, 2
• Do not give additional pneumococcal vaccines after PCV20 unless the patient falls into the rare category requiring shared decision-making 2
• Do not assume all adults <50 years need PCV20—only those with specific risk conditions require vaccination in this age group 1, 2
• Do not overlook current smokers as a risk group—they have substantially elevated risk for invasive pneumococcal disease 2