What are the indications for Prevnar 20 (pneumococcal conjugate vaccine)

Indications for Prevnar 20

Prevnar 20 is indicated for active immunization to prevent invasive pneumococcal disease, pneumonia, and otitis media caused by specific Streptococcus pneumoniae serotypes in individuals aged 6 weeks and older, with universal recommendations for all adults aged ≥50 years. 1, 2

FDA-Approved Indications

Prevention of Invasive Pneumococcal Disease

• Active immunization for prevention of invasive disease caused by S. 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

Prevention of Pneumonia

• Active immunization for prevention of pneumonia caused by the 20 vaccine serotypes in individuals 18 years of age and older. 1
• Note: The indication for serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F was approved under accelerated approval based on immune responses; continued approval is contingent upon confirmatory trials. 1

Prevention of Otitis Media

• Active immunization for 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

Age-Based Recommendations

Adults Aged ≥50 Years

• All adults aged ≥50 years should receive a single dose of PCV20 (or alternative PCV options), regardless of underlying medical conditions. 2
• This represents an expansion from the previous age threshold of ≥65 years, implemented in October 2024. 2

Adults Aged 19-49 Years with Risk Conditions

• Adults aged 19-49 years with specific underlying medical conditions or risk factors should receive PCV20. 3, 4

Risk-Based Indications (Ages 19-49 Years)

Chronic Medical Conditions

• Chronic heart disease (including congestive heart failure, cardiovascular disease, and valve diseases) 3, 4
• Chronic lung disease 3, 4
• Chronic liver disease 3, 4
• Diabetes mellitus 3, 4
• Chronic renal failure 3, 4
• Alcoholism 3
• Current cigarette smoking (associated with 2.8-4.1 times increased risk for invasive pneumococcal disease) 3, 4

Immunocompromising Conditions

• HIV infection 3, 4
• Congenital or acquired immunodeficiencies 3, 4
• Iatrogenic immunosuppression 3, 4
• Generalized malignancy 3, 4
• Hodgkin disease 3, 4
• Leukemia 3, 4
• Lymphoma 3, 4
• Multiple myeloma 3, 4
• Solid organ transplant 3, 4
• Sickle cell disease or other hemoglobinopathies 4
• Congenital or acquired asplenia 3

Anatomic/Functional Conditions

• Cerebrospinal fluid (CSF) leak 3
• Cochlear implant 3

Vaccination Schedules by Prior Pneumococcal Vaccination Status

Pneumococcal Vaccine-Naïve Adults

• Administer one dose of PCV20 alone. 3, 4
• This is the preferred simplified regimen for all eligible adults without prior pneumococcal vaccination. 3

Adults Who Previously Received PPSV23 Only

• Administer one dose of PCV20 at least 1 year after the last PPSV23 dose. 4

Adults Who Previously Received PCV13 Only

• Administer one dose of PCV20 at least 1 year after the PCV13 dose. 4
• For immunocompromised adults, this interval can be as short as 1 year. 4

Adults Who Completed Series with Both PCV13 and PPSV23

• Shared clinical decision-making is recommended regarding administration of PCV20 for adults aged ≥65 years who completed the recommended vaccine series with both PCV13 and PPSV23. 3
• If a decision to administer PCV20 is made, give a single dose ≥5 years after the last pneumococcal vaccine dose. 3, 4

Key Clinical Considerations

Completion of Vaccination Series

• After PCV20 administration, no additional pneumococcal vaccines are needed in most scenarios, as PCV20 provides comprehensive coverage. 4

Immunocompromised Patients

• For immunocompromised adults who received PCV13 and one dose of PPSV23, administer PCV20 ≥5 years after the last pneumococcal vaccine dose. 4
• The minimum interval between PCV15 and PPSV23 can be shortened to 8 weeks in immunocompromised adults (though this applies to the PCV15 series, not PCV20). 4

Mortality Benefit

• Pneumococcal vaccination has been associated with a 22% reduction in all-cause mortality among adults with cardiovascular disease or very high cardiovascular risk. 3, 4

Common Pitfalls to Avoid

• Do not administer additional pneumococcal vaccines after PCV20 completion unless new recommendations emerge. 4
• Ensure minimum intervals are met: at least 1 year after PPSV23 or PCV13, and at least 5 years for those who completed both PCV13 and PPSV23 series. 3, 4
• Do not overlook younger adults (19-49 years) with risk conditions, as they require risk-based vaccination regardless of age. 3
• Remember that current smokers have significantly elevated risk (2.8-4.1 times) for invasive pneumococcal disease and qualify for vaccination. 3, 4