PCV20 Vaccine Recommendations
Primary Recommendation
All adults aged ≥65 years should receive a single dose of PCV20 (or alternatively PCV15 followed by PPSV23 ≥1 year later), and adults aged 19-64 years with chronic medical conditions (chronic heart disease, chronic lung disease, diabetes mellitus, chronic liver disease, alcoholism, or cigarette smoking) or immunocompromising conditions should also receive PCV20. 1
Age-Based Recommendations
Adults ≥65 Years
- Administer a single dose of PCV20 to all adults aged ≥65 years who have never received a pneumococcal conjugate vaccine 1, 2
- This completes the pneumococcal vaccination series; no additional doses are needed 2
- Note: As of October 2024, ACIP expanded recommendations to include all adults aged ≥50 years 3
Adults 19-64 Years with Chronic Medical Conditions
- Administer a single dose of PCV20 to adults with the following conditions 1:
Adults 19-64 Years with Immunocompromising Conditions
- Administer a single dose of PCV20 to adults with 1:
- HIV infection 1, 2
- Congenital or acquired immunodeficiencies 1
- Iatrogenic immunosuppression (including long-term systemic corticosteroids) 1
- Generalized malignancy, Hodgkin disease, leukemia, lymphoma, or multiple myeloma 1
- Chronic renal failure or nephrotic syndrome 1
- Solid organ transplant 1, 2
- Congenital or acquired asplenia or sickle cell disease 1
- Cochlear implant or CSF leak 1
Recommendations Based on Prior Vaccination History
Never Vaccinated or Unknown History
Previously Received PPSV23 Only
- Administer a single dose of PCV20 ≥1 year after the last PPSV23 dose 1, 2
- This completes the pneumococcal vaccination series 2
Previously Received PCV13 Only
- Administer a single dose of PCV20 ≥1 year after the PCV13 dose 1, 2
- For adults aged 19-64 years with chronic medical conditions only, this completes the series 1
- For adults aged 19-64 years with immunocompromising conditions, this completes the series 2
- For adults aged ≥65 years, this completes the series 2
Previously Received Both PCV13 and PPSV23
For adults aged 19-64 years with chronic medical conditions:
- No additional vaccines are recommended at this time 1
- Review pneumococcal vaccine recommendations again when the patient turns 65 years 1
For adults aged ≥65 years who received both PCV13 and PPSV23 (with PPSV23 given at age ≥65):
- Use shared clinical decision-making regarding administration of PCV20 1, 2
- If the decision is made to give PCV20, administer it ≥5 years after the last pneumococcal vaccine dose 1, 2
- This is particularly relevant for patients with immunocompromising conditions or multiple chronic conditions who may benefit from additional serotype coverage 1
For adults aged 19-64 years with immunocompromising conditions who received both PCV13 and PPSV23:
- Administer PCV20 ≥5 years after the last pneumococcal vaccine dose 2
Special Populations
Hematopoietic Stem Cell Transplant (HSCT) Recipients
- Administer 3 doses of PCV20, 4 weeks apart, starting 3-6 months after HSCT 1, 2
- Administer a fourth dose of PCV20 ≥6 months after the third dose OR ≥12 months after HSCT, whichever is later 1
- If chronic graft-versus-host disease (GVHD) is present and PCV15 is used instead, administer a fourth dose of PCV15 rather than PPSV23 1
Immunocompromised Adults: Shortened Intervals
- For adults with immunocompromising conditions, CSF leak, or cochlear implant, the minimum interval between PCV15 and PPSV23 can be shortened to ≥8 weeks (rather than the standard ≥1 year) 1, 2
- This applies when using the PCV15/PPSV23 series rather than PCV20 alone 1
Alternative Vaccination Schedule
If PCV20 is unavailable, the following alternative is acceptable 1:
- Administer PCV15 followed by PPSV23 ≥1 year later (or ≥8 weeks for immunocompromised patients) 1, 2
- Both doses are required to complete the series when using this approach 2
Key Clinical Considerations
Timing After Acute Illness
- PCV20 can be administered immediately once the patient has clinically recovered from acute pneumonia or other illness 2
- No waiting period is required after pneumonia itself; only intervals based on prior pneumococcal vaccination history apply 2
Coadministration with Other Vaccines
- PCV20 may be administered at the same visit as other age-appropriate vaccines (including COVID-19 vaccines) at different anatomic sites 1, 4
Completion of Series
- After PCV20 administration, the pneumococcal vaccination series is complete in most scenarios 2
- Do not administer PPSV23 after PCV20; it is unnecessary and not recommended 2
Common Pitfalls to Avoid
Interval Violations
- Do not administer PCV20 <1 year after PCV13 or PPSV23 (except in the shared decision-making scenario where ≥5 years is required) 1, 2
- Violating these intervals may result in suboptimal immune response 2
Unnecessary Additional Doses
- Do not add PPSV23 after PCV20; once PCV20 is given, the series is complete 2
- For adults aged 19-64 years with chronic medical conditions who received both PCV13 and PPSV23, do not give additional doses until they turn 65 years 1
Incomplete Series with PCV15
- If PCV15 is chosen instead of PCV20, PPSV23 must follow to complete the series; PCV15 alone is insufficient 2
Safety and Tolerability
- PCV20 is well tolerated with local reactions, systemic events, and adverse events comparable to PCV13 and PPSV23 5
- Serious adverse events and newly diagnosed chronic medical conditions are rare 5
- PCV20 has been shown to be safe and immunogenic in adults ≥65 years regardless of prior pneumococcal vaccination history 5
Immunogenicity and Efficacy
- PCV20 induces robust immune responses including opsonophagocytic antibody responses to all 20 vaccine serotypes 5
- Immune responses are maintained regardless of prior pneumococcal vaccination with PPSV23, PCV13, or both 5
- PCV20 provides broader serotype coverage than PCV13 (7 additional serotypes) and PCV15 (5 additional serotypes), addressing common serotypes causing invasive pneumococcal disease and community-acquired pneumonia 6, 7