Recommended Waiting Period After PCV13 and PPSV23 Before Receiving PCV20
If you have received both Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23), you should wait at least 5 years after the last pneumococcal vaccine dose before getting Prevnar 20. 1
Clinical Guidance Based on Vaccination History
The specific waiting period depends on your exact vaccination history and age:
For Adults ≥65 Years Who Received Both PCV13 and PPSV23
If PPSV23 was given at age ≥65 years: Shared clinical decision-making is recommended regarding whether to administer PCV20, and if given, it should be administered ≥5 years after the last pneumococcal vaccine dose. 1
If PPSV23 was given before age 65 years: A single dose of PCV20 should be administered ≥5 years after the last pneumococcal vaccine dose. 1
For Adults 19-64 Years with Immunocompromising Conditions
- If you received both PCV13 and one dose of PPSV23: PCV20 should be administered ≥5 years after the last pneumococcal vaccine dose. 1
Important Considerations About Timing
Why the 5-Year Interval Matters
The FDA drug label for Prevnar 20 specifically notes that receipt of PPSV23 within 1 to 5 years prior to PCV20 resulted in diminished immune responses compared to those who received PCV13 followed by PPSV23 with at least 1 year between PPSV23 and PCV20. 2
This evidence demonstrates that prior PPSV23 vaccination can interfere with the immune response to subsequent PCV20, making the 5-year interval critical for optimal protection. 2
Shorter Intervals for Different Scenarios
If you received only PCV13 (without PPSV23):
- Wait ≥1 year after the PCV13 dose before receiving PCV20. 1, 3
- For immunocompromised adults, this same ≥1 year interval applies. 1
If you received only PPSV23 (without PCV13):
Key Clinical Pitfalls to Avoid
Do not administer PCV20 too soon after PPSV23: The 5-year interval when both vaccines were previously given is based on immunologic evidence showing reduced responses with shorter intervals. 1, 2
After receiving PCV20, no additional pneumococcal vaccines are needed: Once PCV20 is administered, the pneumococcal vaccination series is complete for most patients. 3, 4
Do not confuse the intervals: The 1-year interval applies only when a single prior pneumococcal vaccine was given (either PCV13 alone or PPSV23 alone), while the 5-year interval applies when both PCV13 and PPSV23 were previously administered. 1
Rationale for These Recommendations
The 2024 ACIP guidelines represent the most current evidence-based recommendations for pneumococcal vaccination in adults. 1
These intervals are designed to optimize immune responses while providing broader serotype coverage against pneumococcal disease. 1
The extended 5-year interval after receiving both vaccines reflects the immunologic interference that can occur when conjugate vaccines are given too soon after polysaccharide vaccines. 2