What is the Pneumococcal (PCV) 20 vaccination guideline for high-risk individuals, including adults aged 65 and older or those with immunocompromising conditions such as chronic heart disease, lung disease, or diabetes?

PCV20 Vaccination Guidelines

Primary Recommendation

All adults aged ≥65 years and adults aged 19-64 years with chronic medical conditions (including chronic heart disease, chronic lung disease, diabetes mellitus) or immunocompromising conditions should receive a single dose of PCV20, or alternatively PCV15 followed by PPSV23 at least 1 year later. 1

Vaccination Schedule Based on Prior Pneumococcal Vaccination History

For Adults Who Never Received Pneumococcal Vaccine

• Administer a single dose of PCV20 1, 2
• This completes the pneumococcal vaccination series; no additional doses needed 2

For Adults Who Previously Received PPSV23 Only

• Administer a single dose of PCV20 at least 1 year after the last PPSV23 dose 1, 2
• This completes the series 2

For Adults Who Previously Received PCV13 Only

• Administer a single dose of PCV20 at least 1 year after the PCV13 dose 1, 2
• For adults aged 19-64 years with chronic medical conditions who received PCV13, either PCV20 or PPSV23 should be given at least 1 year after PCV13 1
• Review recommendations again when patient turns 65 years 1

For Adults Who Previously Received Both PCV13 and PPSV23

• For adults aged 19-64 years with chronic medical conditions: No additional vaccine is indicated at this time 1
• Review recommendations again when patient turns 65 years 1
• For adults aged ≥65 years: Shared clinical decision-making regarding a single dose of PCV20 at least 5 years after the last pneumococcal vaccine dose 1, 2

High-Risk Populations Requiring PCV20

Chronic Medical Conditions (Ages 19-64 Years)

• Chronic heart disease (including congestive heart failure and cardiomyopathies) 1
• Chronic lung disease (including COPD, emphysema, and asthma) 1
• Chronic liver disease 1
• Diabetes mellitus (type 1 or type 2) 1
• Alcoholism 1
• Cigarette smoking 1

Immunocompromising Conditions (All Ages ≥19 Years)

• Congenital or acquired immunodeficiencies 1
• HIV infection 1
• Chronic renal failure or nephrotic syndrome 1
• Iatrogenic immunosuppression (including long-term systemic corticosteroids) 1
• Generalized malignancy 1
• Hodgkin disease, leukemia, lymphoma, multiple myeloma 1
• Solid organ transplant 1
• Congenital or acquired asplenia 1
• Sickle cell disease or other hemoglobinopathies 1, 2

Other High-Risk Conditions

• Cerebrospinal fluid (CSF) leak 1
• Cochlear implant 1

Critical Timing Intervals

Standard Intervals

• Minimum 1 year interval between PPSV23 and PCV20 1, 2
• Minimum 1 year interval between PCV13 and PCV20 1, 2
• Minimum 1 year interval between PCV15 and PPSV23 1

Shortened Intervals for Immunocompromised Patients

• Adults with immunocompromising conditions, CSF leak, or cochlear implant may benefit from shorter intervals of at least 8 weeks between PCV15 and PPSV23 1
• This shortened interval applies only to the PCV15-to-PPSV23 sequence, not to PCV20 administration 1

Extended Intervals

• Minimum 5 years between last pneumococcal vaccine dose and PCV20 for adults who completed both PCV13 and PPSV23 series 1, 2

Special Population: Hematopoietic Stem Cell Transplant (HSCT) Recipients

Primary Recommendation

• Administer 3 doses of PCV20, 4 weeks apart, starting 3-6 months after HSCT 1
• Fourth dose of PCV20 at least 6 months after the third dose OR at least 12 months after HSCT, whichever is later 1

Alternative if PCV20 Unavailable

• Administer 3 doses of PCV15, 4 weeks apart, starting 3-6 months after HSCT 1
• Follow with PPSV23 at least 12 months after HSCT if no chronic graft-versus-host disease (GVHD) 1
• If chronic GVHD present, administer fourth dose of PCV15 instead of PPSV23 1

Common Pitfalls and Caveats

Do Not Repeat Doses Unnecessarily

• Vaccines administered at age <65 years for immunocompromising conditions do not need to be repeated at age ≥65 years 1
• Once PCV20 is administered, the pneumococcal vaccination series is complete; no additional doses needed 2

Do Not Add PPSV23 After PCV20

• PCV20 alone provides comprehensive coverage; PPSV23 should not be added after PCV20 2

Verify Minimum Intervals

• Do not administer PCV20 before the minimum 1-year interval after prior PCV13 or PPSV23 1, 2
• The 5-year interval applies only when both PCV13 and PPSV23 were previously given 1, 2

Review at Age 65

• For adults aged 19-64 years who received pneumococcal vaccines, review recommendations again when they turn 65 years 1

Clinical Rationale

Why PCV20 Over PPSV23 Alone

• Conjugate vaccines like PCV20 induce T-cell dependent immune responses and immunologic memory, providing superior immunogenicity compared to polysaccharide vaccines 2
• PCV20 provides broader serotype coverage (20 serotypes) compared to PCV13 (13 serotypes) or PCV15 (15 serotypes) 2, 3

Disease Burden in High-Risk Groups

• Adults with COPD have 18 times the risk for community-acquired pneumonia compared to those without COPD 1
• Adults with diabetes have 1.4-5.9 times the risk for invasive pneumococcal disease 1
• Current smokers have 2.8-4.1 times the risk for invasive pneumococcal disease 2

Safety and Tolerability

• PCV20 demonstrates comparable safety profiles to PCV13 and PPSV23, with most adverse events being mild to moderate 3, 4
• PCV20 is well tolerated regardless of prior pneumococcal vaccination history 3