What is the recommended dosing and administration schedule for Pneumococcal Conjugate Vaccine 20 (PCV20)?

How to Prescribe PCV20

Administer a single 0.5 mL dose of PCV20 intramuscularly, with the specific timing and eligibility determined by the patient's age, prior pneumococcal vaccination history, and underlying medical conditions. 1, 2, 3

Basic Administration

• Give PCV20 as a single 0.5 mL intramuscular injection using the pre-filled syringe after shaking vigorously to achieve a homogeneous white suspension 4
• Administer in the deltoid muscle for adults 4
• Once PCV20 is given, the pneumococcal vaccination series is complete—no additional pneumococcal vaccines are needed (except in HSCT recipients) 2, 3

Age-Based Recommendations

Adults ≥65 Years

• For vaccine-naïve patients: Give a single dose of PCV20 immediately 1, 2, 3
• This is the preferred option over the PCV15/PPSV23 series due to simplicity and completion in one dose 2

Adults 50-64 Years

• For vaccine-naïve patients: Give a single dose of PCV20 5
• This expanded recommendation was added in October 2024 5

Adults 19-49 Years

• Give PCV20 only if the patient has immunocompromising conditions (HIV, congenital/acquired immunodeficiencies, iatrogenic immunosuppression, malignancy, transplant recipients, asplenia, CSF leak, cochlear implant) 1, 6
• Also give PCV20 if the patient has chronic medical conditions (chronic heart disease, chronic lung disease, chronic liver disease, diabetes, alcoholism, or cigarette smoking) 6

Prescribing Based on Prior Vaccination History

Previously Received PPSV23 Only

• Give PCV20 ≥1 year after the last PPSV23 dose 1, 2, 3
• This applies regardless of age or how many PPSV23 doses were given 1, 2
• The series is complete after PCV20—no additional PPSV23 needed 2, 3

Previously Received PCV13 Only

• For immunocompetent adults: Give PCV20 ≥1 year after the PCV13 dose 1, 3, 6
• For immunocompromised adults: Give PCV20 ≥1 year after the PCV13 dose (same interval as immunocompetent) 3, 6
• The series is complete after PCV20 3, 6

Previously Received Both PCV13 and PPSV23

If PPSV23 was given before age 65:

• Give PCV20 ≥5 years after the last PCV13 or PPSV23 dose (whichever was most recent) 1, 3, 6
• This is a firm recommendation for completing the series 1

If PPSV23 was given at age ≥65:

• Use shared clinical decision-making to consider PCV20 ≥5 years after the last dose 1, 2
• This is optional, not required—the series is technically complete 1, 2
• Consider giving PCV20 if the patient has immunocompromising conditions for additional serotype coverage 6

Previously Received PCV7 Only

• Treat as vaccine-naïve and give PCV20 according to age-based recommendations 1

Special Population: Hematopoietic Stem Cell Transplant (HSCT) Recipients

This is the only scenario requiring multiple PCV20 doses: 1, 3

• Give 4 doses of PCV20 starting 3-6 months after HSCT 1, 3
• First 3 doses: Give 4 weeks apart 1, 3
• Fourth dose: Give ≥6 months after the third dose OR ≥12 months after HSCT, whichever is later 1, 3
• If PCV20 is unavailable, use 3 doses of PCV15 (4 weeks apart) followed by PPSV23 ≥1 year after HSCT 1

Critical Timing Intervals to Remember

• ≥1 year interval: Required after PPSV23 or PCV13 before giving PCV20 (most common scenario) 1, 2, 3
• ≥5 year interval: Required when both PCV13 and PPSV23 were previously given 1, 3, 6
• ≥8 weeks interval: Only applies to PCV15 followed by PPSV23 in immunocompromised patients (not relevant for PCV20 alone) 1, 2

Common Pitfalls to Avoid

• Do not give PPSV23 after PCV20—the series is complete with PCV20 alone 2, 3
• Do not give PCV20 too soon—respect the minimum 1-year interval after prior pneumococcal vaccines (or 5 years if both PCV13 and PPSV23 were given) 1, 3, 6
• Do not give multiple PCV20 doses to non-HSCT patients—only HSCT recipients need a 4-dose series 1, 3
• Do not co-administer PCV20 with other pneumococcal vaccines on the same day 2, 4
• Do not delay vaccination waiting for complete medical records—use verbal history and proceed if indicated 2

Documentation

• Record the date of PCV20 administration clearly 2
• Document that the pneumococcal vaccination series is complete (except for HSCT recipients) 2, 3
• Note any prior pneumococcal vaccines and dates to guide future providers 2