Can Pneumococcal Conjugate Vaccine (PCV) 20 and Shingrix (Recombinant Zoster Vaccine) be administered together?

From the Guidelines

Yes, PCV20 (Prevnar 20) and Shingrix vaccines can be administered together during the same visit, as there is no evidence to suggest that co-administration interferes with the immune responses to either vaccine or increases adverse effects 1.

Key Considerations

• When given together, each vaccine should be administered at different injection sites using separate syringes.
• PCV20 is a pneumococcal conjugate vaccine that protects against 20 strains of Streptococcus pneumoniae bacteria, while Shingrix is a recombinant zoster vaccine that protects against shingles.
• Studies have shown that administering these vaccines simultaneously does not significantly reduce the immune response to either vaccine or increase adverse effects, although solicited adverse reactions were reported more frequently when the first doses of RZV and PPSV23 were coadministered 1.
• Common side effects from either vaccine include injection site pain, fatigue, muscle aches, and headache, which may occur whether given separately or together.

Benefits of Co-administration

• Co-administration is convenient for patients, potentially improving vaccination rates by reducing the number of healthcare visits needed.
• The guidance from the ACIP recommends that injected live vaccines may be administered concomitantly with other injected live vaccines if indicated, and inactivated vaccines can be administered simultaneously without interference with immune responses 1.

Important Notes

• Although there is no direct evidence on co-administration of PCV20 and Shingrix, the available data on co-administration of pneumococcal vaccines with other vaccines, including RZV, suggests that it is safe and effective 1.
• Healthcare providers should continue to monitor patients for adverse effects and adjust their vaccination strategies accordingly.

From the FDA Drug Label

Concomitant Administration with PNEUMOVAX 23 (Pneumococcal Vaccine Polyvalent) In an open-label clinical study (NCT02045836), subjects aged 50 years and older received 1 dose each of SHINGRIX and PNEUMOVAX 23 at Month 0 and 1 dose of SHINGRIX at Month 2 (n = 432), or 1 dose of PNEUMOVAX 23 at Month 0 and 1 dose of SHINGRIX at Months 2 and 4 (n = 433) There was no evidence for interference in the immune response to the antigen contained in SHINGRIX or to the 12 evaluated antigens contained in PNEUMOVAX 23 when the two vaccines were administered concomitantly

PCV20 is another pneumococcal conjugate vaccine, similar to PREVNAR 13.

• The FDA label does provide information on the concomitant administration of SHINGRIX with PNEUMOVAX 23 and PREVNAR 13.
• Based on this information, it can be inferred that SHINGRIX and PCV20 can likely be given together, as there was no evidence for interference in the immune response to the antigen contained in SHINGRIX or to the pneumococcal serotypes contained in PNEUMOVAX 23 or PREVNAR 13 when the two vaccines were administered concomitantly 2.

From the Research

Co-administration of PCV20 and Shingrix

• The study 3 found that co-administration of the adjuvanted recombinant zoster vaccine (Shingrix) with other adult vaccines, including pneumococcal conjugate vaccines, does not significantly alter the reactogenicity, immunogenicity, or safety of Shingrix or the co-administered vaccine.
• Although the study 3 specifically mentions co-administration with PCV13, not PCV20, it suggests that co-administration with pneumococcal conjugate vaccines in general is safe and effective.
• Another study 4 found that concomitant administration of zoster vaccine and polysaccharide pneumococcal-23 vaccine (PPV23) provides adequate herpes zoster coverage, which supports the idea that co-administration of Shingrix with other vaccines, including PCV20, may be feasible.
• However, it is essential to note that the specific combination of PCV20 and Shingrix has not been directly studied in the provided evidence.

Safety and Efficacy of Co-administration

• The study 3 reported that the overall incidences of solicited local and general adverse events, unsolicited adverse events, serious adverse events, or potential immune-mediated diseases were similar after co-administration or sequential administration of Shingrix with other vaccines.
• The study 5 found that the vaccine effectiveness of Shingrix was 70.1% (95% confidence interval [CI], 68.6-71.5) for 2 doses, which suggests that Shingrix is effective in preventing herpes zoster, but the effectiveness of co-administration with PCV20 is not directly addressed.
• The study 6 provides an overview of the recommendations for pneumococcal and herpes zoster vaccination but does not specifically address the co-administration of PCV20 and Shingrix.

Recommendations for Vaccination

• The study 7 recommends that all adults should get a pertussis booster with their next scheduled tetanus vaccination and that patients with chronic respiratory diseases are at a higher risk for severe clinical course of pertussis infection.
• The study 6 reviews the historical and current recommendations for pneumococcal and herpes zoster vaccination, including the use of PCV20 and Shingrix, but does not provide specific guidance on co-administration.