Can a Patient Shift from PCV13 to PCV20?
Yes, patients who have previously received PCV13 can and should receive PCV20 to expand their pneumococcal protection, with the timing dependent on their specific clinical circumstances. 1
Recommended Timing Based on Clinical Status
For Immunocompetent Adults ≥65 Years
- Administer a single dose of PCV20 at least 1 year after the PCV13 dose 1, 2
- This represents the standard interval for adults without immunocompromising conditions, CSF leak, or cochlear implant 1
- Once PCV20 is administered, the pneumococcal vaccination series is complete and no additional pneumococcal vaccines are needed 2, 3
For Immunocompromised Adults (19-64 Years)
- Administer a single dose of PCV20 at least 1 year after the PCV13 dose 2
- This applies to patients with chronic renal failure, asplenia, HIV infection, malignancies, immunosuppressive therapy, sickle cell disease, transplant recipients, and complement deficiencies 1, 4
- The series is complete after PCV20 administration, with no additional doses required 2, 3
For Adults with Chronic Medical Conditions (19-64 Years)
- Administer a single dose of PCV20 at least 1 year after the PCV13 dose 2
- Chronic conditions include diabetes, chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, or cigarette smoking 2
- This completes the pneumococcal vaccine series 2
Special Circumstance: Prior PCV13 AND PPSV23
If PPSV23 Was Given BEFORE Age 65
- Administer PCV20 at least 5 years after the most recent pneumococcal vaccine dose (whichever was last) 1, 2
- This extended interval is required when both vaccines have been previously administered 2
If PPSV23 Was Given AT Age ≥65
- Shared clinical decision-making is recommended regarding whether to administer PCV20 1, 4
- If the decision is made to vaccinate, PCV20 should be given at least 5 years after the last pneumococcal vaccine dose 1, 2
- This represents an optional additional dose, not a required vaccination 2
Clinical Rationale for Transitioning to PCV20
Immunologic Advantages
- Conjugate vaccines like PCV20 generate T-cell dependent responses and immunologic memory, which are superior to the T-cell independent responses from PPSV23 2
- PCV20 provides coverage against 20 pneumococcal serotypes, expanding protection beyond PCV13's 13 serotypes 5, 6
- The 7 additional serotypes in PCV20 (8, 10A, 11A, 12F, 15B, 22F, and 33F) are important contributors to invasive pneumococcal disease 7, 8
Safety and Efficacy Evidence
- Phase 3 clinical trials demonstrated that PCV20 is safe and immunogenic in adults previously vaccinated with PCV13, regardless of the interval between vaccines (ranging from 6 months to 5 years) 2, 6
- The safety profile of PCV20 is similar to PCV13, with comparable rates of local reactions, systemic events, and adverse events 6, 8, 9
- Robust opsonophagocytic antibody responses to all 20 vaccine serotypes were observed after PCV20 administration in previously vaccinated adults 6, 9
Critical Implementation Points
Minimum Interval Requirements
- Never administer PCV20 sooner than 1 year after PCV13 1, 2
- The 1-year minimum interval must be observed for optimal immune response 2
- If both PCV13 and PPSV23 were previously given, the minimum interval extends to 5 years 1, 2
Series Completion
- After PCV20 administration, no additional pneumococcal vaccines are needed in most scenarios 2, 3
- Do not add PPSV23 after PCV20, as this is unnecessary and not recommended 2
- Document clearly that the pneumococcal vaccination series is complete 2, 3
Common Pitfalls to Avoid
- Do not give PCV20 too soon: The 1-year minimum interval after PCV13 must be observed 2
- Do not add PPSV23 after PCV20: Once PCV20 is administered, the series is complete 2
- Do not confuse the intervals: Use 1 year after PCV13 alone, but 5 years if both PCV13 and PPSV23 were previously given 1, 2
- Do not delay vaccination waiting for complete medical records: Use verbal history and proceed with vaccination if indicated 4