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Pneumococcal conjugate vaccine (20-valent) (PCV20): Pediatric drug information

Pneumococcal conjugate vaccine (20-valent) (PCV20): Pediatric drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
Brand Names: US
  • Prevnar 20
Brand Names: Canada
  • Prevnar 20
Therapeutic Category
  • Vaccine;
  • Vaccine, Inactivated (Bacterial)
Dosing: Pediatric

Dosage guidance:

Dosing: According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2023]).

Pneumococcal disease prevention

Pneumococcal disease prevention:

Note: Number and timing of doses depends on age when series initiated, previous receipt of other pneumococcal conjugate vaccines (PCVs), and presence of conditions that increase the risk for pneumococcal disease. For details, see ACIP recommendations (CDC/ACIP [Farrar 2023]).

Infants ≥6 weeks and Children <2 years: Note: A series started with pneumococcal conjugate vaccine 13-valent (PCV13) may be completed with pneumococcal conjugate vaccine 15-valent (PCV15) or pneumococcal conjugate vaccine 20-valent (PCV20) without restarting the series (CDC/ACIP [Farrar 2023]).

First dose at 2 months of age: IM: 0.5 mL per dose for a total of 4 doses given at 2, 4, 6, and 12 through 15 months of age. The first dose may be given as young as 6 weeks of age; the fourth dose should be given ≥2 months after the third (CDC/ACIP [Farrar 2023]; manufacturer's labeling).

Catch-up dosing: Note: If the initial PCV dose is not administered before 6 months of age, the number of doses for series completion and timing varies.

First dose at 7 to <12 months of age: IM: 0.5 mL per dose for a total of 3 doses; administer the second dose ≥4 weeks after the first; administer the third dose ≥8 weeks after the second dose and after the first birthday (ACIP/CDC [Farrar 2023]; ACIP/CDC [Kobayashi 2022]; manufacturer's labeling).

First dose at 12 months to <2 years of age: IM: 0.5 mL per dose for 2 doses administered ≥8 weeks apart (ACIP/CDC [Farrar 2023]; ACIP/CDC [Kobayashi 2022]; manufacturer's labeling).

Children ≥2 years and Adolescents:

Patients WITHOUT any conditions that increase the risk for pneumococcal disease (ie, healthy children) with an incomplete PCV status:

Children 2 to <5 years: IM: 0.5 mL as a single dose (ACIP/CDC [Farrar 2023]); manufacturer's labeling).

Children ≥5 years and Adolescents: IM: ACIP does not recommend use of PCV20 in healthy children in this age group; however, the manufacturer's labeling allows a single 0.5 mL dose to be administered to patients <18 years of age who have never received a PCV (ACIP/CDC [Farrar 2023]); manufacturer's labeling).

Patients WITH any condition that increases the risk for pneumococcal disease:

Children 2 to <6 years:

Patients who received <3 doses of any PCV by 2 years of age: IM: 0.5 mL per dose for 2 doses separated by ≥8 weeks (ACIP/CDC [Farrar 2023]; ACIP/CDC [Kobayashi 2022]).

Patients who received 3 doses of any PCV prior to 12 months of age: IM: 0.5 mL as a single dose ≥8 weeks after the last PCV dose (ACIP/CDC [Farrar 2023]).

Patients with complete PCV series that did not include any PCV20 doses as part of series (ie, series completed with PCV13 or PCV15): IM: 0.5 mL per dose as a single dose.

Children ≥6 years and Adolescents:

Patients who have not received any dose of PCV: IM: 0.5 mL per dose as a single dose; if pneumococcal polysaccharide vaccine 23-valent (PPSV23) has been administered, separate by ≥8 weeks (CDC/ACIP [Farrar 2023]).

Patients with complete PCV series that did not include any PCV20 doses as part of series (ie, series completed with PCV13 or PCV15): IM: 0.5 mL per dose as a single dose. Note: If PPSV23 was administered in a patient with an immunocompromising condition, the PCV20 dose should be administered ≥5 years after the PPSV23 dose (CDC/ACIP [Farrar 2023]).

Pneumococcal disease prevention following hematopoietic stem cell transplantation

Pneumococcal disease prevention following hematopoietic stem cell transplantation (HSCT):

Infants, Children, and Adolescents: IM: 0.5 mL per dose for a total of 4 doses initiated 3 to 6 months following HSCT in consultation with the patient's clinical team. Administer the second dose ≥4 weeks after the first and the third dose ≥4 weeks after the second. Administer the fourth dose ≥6 months after the third, or ≥12 months after HSCT, whichever is later (CDC/ACIP [Farrar 2023]).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Pneumococcal conjugate vaccine (20-valent) (PCV20): Drug information")

Note: According to the Advisory Committee on Immunization Practices, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2023]).

Pneumococcal disease prevention

Pneumococcal disease prevention:

CDC/ACIP recommendations: PCV20: IM: 0.5 mL as a single dose; see the following recommendations based on age, prior pneumococcal vaccination, and comorbid conditions/risk factors (CDC/ACIP [Kobayashi 2023]). For additional guidance, the CDC recommends using the PneumoRecs VaxAdvisor (mobile app or web version https://www2a.cdc.gov/vaccines/m/pneumo/agegroup.html).

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with Certain Chronic Health Conditions or Other Risk Factorsa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Includes alcohol use disorder, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus.

b Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

c PCV20 available.

d PCV15 and PPSV23 available.

e Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

f Review recommendations again when patient turns 65 years of age.

Nonee

PCV20

PCV15 followed by PPSV23 ≥1 year later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥1 year laterf

PCV13 and PPSV23

No additional pneumococcal vaccine at this time.f

PCV15 only

PPSV23 ≥1 year later

PCV20 only

No additional pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with Specified Immunocompromising Conditionsa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Includes asplenia (congenital or acquired), chronic renal failure, generalized malignancy, HIV infection, Hodgkin disease, immunodeficiencies (congenital or acquired), immunosuppression (iatrogenic, including immunosuppressive therapies), leukemia, lymphoma, multiple myeloma, nephrotic syndrome, sickle cell disease and other hemoglobinopathies, solid organ transplant. Excludes hematopoietic cell transplant (HCT).

b Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

c PCV20 available.

d PCV15 and PPSV23 available.

e Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

f Review recommendations again when patient turns 65 years of age.

Nonee

PCV20

PCV15 followed by PPSV23 ≥8 weeks later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥8 weeks later followed by another PPSV23 dose ≥5 years laterf

PCV13 and 1 dose of PPSV23

PCV20 administered ≥5 years later

PPSV23 administered ≥5 years laterf

PCV13 and 2 doses of PPSV23

PCV20 administered ≥5 years later

No additional pneumococcal vaccine at this timef

PCV15 only

PPSV23 administered ≥8 weeks later

PCV20 only

No additional pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients 19 to 64 Years of Age with a Cochlear Implant or Cerebrospinal Fluid Leaka

Prior pneumococcal vaccination

Option Ab

Option Bc

a Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

b PCV20 available.

c PCV15 and PPSV23 available.

d Also applies to patients who previously received PCV7 (at any age) but no other pneumococcal vaccines or unknown vaccination status.

e Review recommendations again when patient turns 65 years of age.

Noned

PCV20

PCV15 followed by PPSV23 ≥8 weeks later

PPSV23 only

PCV20 administered ≥1 year later

PCV15 administered ≥1 year later

PCV13 only

PCV20 administered ≥1 year later

PPSV23 administered ≥8 weeks latere

PCV13 and 1 dose of PPSV23

PCV20 administered ≥5 years later

No additional pneumococcal vaccine at this timee

PCV15 only

PPSV23 administered ≥8 weeks latere

PCV20 only

No pneumococcal vaccine at this time.

Pneumococcal Vaccination for Patients ≥19 Years of Age after HCTa,b

Prior pneumococcal vaccination

Option Ac

Option Bd

a Vaccine abbreviations: Pneumococcal conjugate vaccine 20-valent = PCV20; Pneumococcal conjugate vaccine 15-valent = PCV15; Pneumococcal conjugate vaccine 13-valent = PCV13; Pneumococcal polysaccharide vaccine 23-valent = PPSV23. Refer to individual monographs for additional information.

b Four doses of a pneumococcal vaccine after HCT are needed to complete the series.

c PCV20 available.

d PCV15 and PPSV23 available.

e Whichever time point is later; consult with transplant providers for optimal timing.

None after HCT

Three doses of PCV20 administered 4 weeks apart beginning 3 to 6 months after HCT; administer fourth dose of PCV20 ≥6 months after third dose of PCV20 or ≥1 year from HCTe

Three doses of PCV15 administered 4 weeks apart beginning 3 to 6 months after HCT, followed by PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

1 dose of PCV13 or PCV 15 after HCT

Two doses of PCV20 administered 4 weeks apart beginning 4 weeks after last PCV13 or PCV15 dose;administer third dose of PCV20 ≥6 months after second dose of PCV20 or ≥1 year from HCTe

Two doses of PCV15 administered 4 weeks apart beginning 4 weeks after last PCV13 or PCV15 dose; administer PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

2 doses of PCV13 or PCV 15 after HCT

PCV20 administered 4 weeks after last PCV13 or PCV15 dose; administer second dose of PCV20 ≥6 months after first dose of PCV20 or ≥1 year from HCTe

PCV15 administered 4 weeks after last PCV13 or PCV15 dose, followed by PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

3 doses of PCV13 or PCV 15 after HCT

PCV20 administered ≥6 months after last dose of PCV13 or PCV15 or ≥1 year from HCTe

PPSV23 ≥1 year from HCT (administer PCV15 in place of PPSV23 if patient has chronic GVHD).

Canadian recommendations: The Canadian National Advisory Committee on Immunization (NACI) provides different recommendations as compared to the CDC; see NACI recommendations for details.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.

>10%:

Local: Injection-site reaction (53% to 81%, including erythema at injection site [5% to 9%], pain at injection site [50% to 81%], swelling at injection site [4% to 12%])

Nervous system: Fatigue (29% to 43%), headache (14% to 39%)

Neuromuscular & skeletal: Arthralgia (7% to 17%), myalgia (32% to 67%)

1% to 10%: Miscellaneous: Fever (≤2%)

Contraindications

Severe allergic reaction (eg, anaphylaxis) to pneumococcal conjugate vaccine, any component of the formulation, or any diphtheria toxoid-containing vaccine.

Warnings/Precautions

Concerns related to adverse effects:

• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinitis) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).

• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).

Disease-related concerns:

• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Defer administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]).

• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2023]).

Concurrent drug therapy issues:

• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2023]).

• Vaccines: In order to maximize vaccination rates, the Advisory Committee on Immunization Practices recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or non-live) for which a person is eligible at a single visit, unless contraindications exist (ACIP [Kroger 2023]).

Special populations:

• Altered immunocompetence: Consider deferring immunization during periods of severe immunosuppression (eg, patients receiving chemo-/radiation therapy or other immunosuppressive therapy including high-dose corticosteroids); may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines (ACIP [Kroger 2023]; IDSA [Rubin 2014]). Non-live vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; non-live vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2023]; IDSA [Rubin 2014]).

• Older adult: Antibody responses were lower in adults ≥70 years of age compared to adults 18 to 64 years of age.

• Premature infants: Apnea following IM vaccination has been observed in some preterm infants; consider clinical status implications.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). See manufacturer's labeling.

Other warnings/precautions:

• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).

• Appropriate use: Specific recommendations for use of vaccines in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions are available from the Infectious Diseases Society of America (Rubin 2014).

• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Kroger 2023]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension Prefilled Syringe, Intramuscular:

Prevnar 20: 0.5 mL (0.5 mL) [contains polysorbate 80]

Generic Equivalent Available: US

No

Pricing: US

Suspension Prefilled Syringe (Prevnar 20 Intramuscular)

0.5 mL (per 0.5 mL): $313.77

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension Prefilled Syringe, Intramuscular:

Prevnar 20: 0.5 mL (0.5 mL) [contains polysorbate 80]

Administration: Pediatric

Parenteral: IM: Hold syringe horizontally and shake well prior to use; do not use if a homogenous white suspension does not form or if large particulate matter or discoloration is found. Administer IM into the anterolateral thigh or deltoid muscle, as appropriate for age (ACIP [Kroger 2023]). Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2023]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement edition date and date it was provided, and the administering person's name, title, and address be recorded.

For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23-gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2023]).

Administration: Adult

IM: Hold syringe horizontally and shake well prior to use. Do not use if a homogenous white suspension does not form. Administer IM into the deltoid muscle (ACIP [Kroger 2023]). Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope related injuries, patients should be vaccinated while seated or lying down (ACIP [Kroger 2023]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.

For patients at risk of hemorrhage following IM injection, the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23-gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2023]).

Storage/Stability

Store refrigerated at 2°C to 8°C (36°F to 46°F). Do not freeze; discard if frozen. Store syringes in the refrigerator horizontally (lying flat on the shelf) to minimize the redispersion time. Do not exceed 4 days (96 hours) cumulative multiple temperature excursions between 8°C and 25°C (46°F and 77°F). Cumulative multiple excursions between 0°C and 2°C (32°F to 36°F) are also permitted as long as the total time between 0°C and 2°C (32°F to 36°F) does not exceed 72 hours.

Medication Guide and/or Vaccine Information Statement (VIS)

In the United States, the appropriate CDC-approved Vaccine Information Statement (VIS) should be provided to the patient/caregiver before administering each dose of this vaccine. If purchased under CDC contract, the VIS must be provided and the VIS edition date and date it was provided to the patient/caregiver should be recorded. VIS is available at https://www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv.html.

Use

Active immunization for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F (FDA approved in ages ≥6 weeks and adults); active immunization for the prevention of otitis media caused by S. pneumoniae serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F (FDA approved in ages 6 weeks through 5 years); active immunization for the prevention of pneumonia caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F (FDA approved in ages ≥18 years and adults).

Advisory Committee on Immunization Practices (ACIP) Recommendations (CDC/ACIP [Farrar 2023]):

Note: See ACIP recommendations for further details; in some scenarios, additional vaccination with pneumococcal polysaccharide vaccine may be recommended (CDC/ACIP [Farrar 2023]).

Vaccination with pneumococcal conjugate vaccine (PCV15 or PCV20) is recommended for the following:

• All infants and children 2 to <24 months of age

• Children 2 to <5 years of age with an incomplete PCV (PCV13, PCV15, or PCV20) vaccination status

• Children 2 to <6 years of age with any risk condition who have an incomplete PCV vaccination status (<3 doses by 24 months of age)

• Children 2 to <6 years of age with any risk condition who received 3 PCV doses before age 12 months

• Children and Adolescents 2 to <18 years of age with any risk condition who have not received any dose of PCV13, PCV15, or PCV20

Vaccination with PCV20 is recommended for the following:

• Children and Adolescents 2 to <18 years of age with any risk conditions who completed recommended PCV series prior to 6 years of age, if none of administered doses were PCV20

• Children and Adolescents <19 years of age who are hematopoietic stem cell transplant recipients

Conditions that increase the risk of pneumococcal disease (risk conditions):

• Cerebrospinal fluid leak

• Chronic heart disease

• Chronic kidney disease

• Chronic liver disease

• Chronic lung disease, including moderate persistent or severe persistent asthma

• Cochlear implant

• Diabetes mellitus

• Immunocompromising conditions:

- Receiving maintenance dialysis

- Nephrotic syndrome

- Congenital or acquired asplenia or splenic dysfunction

- Congenital or acquired immunodeficiencies, including B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiency), and phagocytic disorders (excluding chronic granulomatous disease)

Medication Safety Issues
Sound-alike/look-alike issues:

PCV20 (pneumococcal 20-valent conjugate vaccine) may be confused with PCV13 (pneumococcal 13-valent conjugate vaccine), PCV15 (pneumococcal 15-valent conjugate vaccine), and PPSV23 (pneumococcal 23-valent polysaccharide vaccine).

Pneumococcal 20-valent conjugate vaccine (Prevnar 20, PCV20) may be confused with pneumococcal 13-valent conjugate vaccine (Prevnar 13, PCV13), pneumococcal 15-valent conjugate vaccine (Vaxneuvance, PCV15), and pneumococcal 23-valent polysaccharide vaccine (Pneumovax 23).

Prevnar 20 (pneumococcal 20-valent conjugate vaccine) may be confused with Prevnar 13 (pneumococcal 13-valent conjugate vaccine).

PCV (pneumococcal conjugate vaccine) may be confused with MCV (meningococcal ACYW conjugate vaccine, MCV4 is the correct abbreviation).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification

Anti-CD20 B-Cell Depleting Therapies: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider therapy modification

Atidarsagene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Atidarsagene Autotemcel may diminish the therapeutic effect of Vaccines. Risk X: Avoid combination

Cladribine: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete Risk D: Consider therapy modification

Corticosteroids (Systemic): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Dinutuximab Beta: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Risk X: Avoid combination

Elivaldogene Autotemcel: May enhance the adverse/toxic effect of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may diminish the therapeutic effect of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid combination

Fingolimod: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider therapy modification

Immunosuppressants (Cytotoxic Chemotherapy): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Immunosuppressants (Miscellaneous Oncologic Agents): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Immunosuppressants (Therapeutic Immunosuppressant Agents): May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Methotrexate: May diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Pneumococcal Polysaccharide Vaccine (23-Valent): May diminish the therapeutic effect of Pneumococcal Conjugate Vaccine (20-Valent). Risk C: Monitor therapy

Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification

Siponimod: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Avoid administration of non-live/inactivated/non-replicating vaccines during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider therapy modification

Teplizumab: May diminish the therapeutic effect of Pneumococcal Vaccines. Management: Vaccination with inactivated vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during therapy, or for 6 weeks after completion of therapy. See full mono for recommendations for number, order, and timing of vaccines. Risk D: Consider therapy modification

Teplizumab: May diminish the therapeutic effect of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Vaccination with non-live/inactivated/non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider therapy modification

Pregnancy Considerations

Antibodies generated following PCV vaccination of pregnant patients can be detected in cord blood (CDC/ACIP [Kobayashi 2023]; Weinberg 2021).

Maternal administration of non-live bacterial vaccines has not been shown to cause increased risks to the fetus (ACIP [Kroger 2023]). Although specific recommendations for vaccination of pregnant patients is not available (CDC/ACIP [Kobayashi 2023]), pneumococcal vaccines may be administered during pregnancy in persons at increased risk of severe disease due to underlying medical conditions (ACOG 2018; ACOG 2022).

Monitoring Parameters

Monitor for anaphylaxis and syncope for 15 minutes following administration (ACIP [Kroger 2023]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Mechanism of Action

Promotes active immunization against pneumonia and invasive disease caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F, all which are individually conjugated to CRM197 protein.

Pharmacokinetics (Adult Data Unless Noted)

Onset: Immune response was elicited by 1 month postvaccination.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (QA) Qatar: Prevenar 20
  1. American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion No. 741: Maternal immunization. Obstet Gynecol. 2018;131(6):e214-e217. doi:10.1097/AOG.0000000000002662 [PubMed 29794683]
  2. American College of Obstetricians and Gynecologists (ACOG). Maternal Immunization Practice Advisory October 2022. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/10/maternal-immunization. Accessed December 13, 2022.
  3. Centers for Disease Control and Prevention (CDC). Pneumococcal vaccine timing for adults. https://www.cdc.gov/pneumococcal/vaccination.html. Updated January 20, 2023. Accessed June 6, 2023.
  4. Cross GB, Moghaddas J, Buttery J, Ayoub S, Korman TM. Don't aim too high: avoiding shoulder injury related to vaccine administration. Aust Fam Physician. 2016;45(5):303-306. [PubMed 27166466]
  5. Farrar JL, Gierke R, Andrejko, et al. ACIP updates: recommendations for use of 20-valent pneumococcal conjugate vaccine in children - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(39):1072. doi:10.15585/mmwr.mm7239a5 [PubMed 37768876]
  6. Foster SL, Davis MV. Vaccine administration: preventing serious shoulder injuries. J Am Pharm Assoc (2003). 2013;53(1):102-103. doi:10.1331/JAPhA.2013.13503 [PubMed 23636163]
  7. Isaksson M, Jansson L. Contact allergy to Tween 80 in an inhalation suspension. Contact Dermatitis. 2002;47(5):312-313. doi:10.1034/j.1600-0536.2002.4705104.x [PubMed 12534540]
  8. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal conjugate vaccine among U.S. children: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(37):1174-1181. doi:10.15585/mmwr.mm7137a3 [PubMed 36107786]
  9. Kobayashi M, Pilishvil T, Gierke R, et al. Pneumococcal Vaccine for Adults Aged ≥ 19 years: recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(3):1-39. doi:10.15585/mmwr.rr7203a1 [PubMed 37669242]
  10. Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization: best practices guidance of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf. Updated February 10, 2023. Accessed May 4, 2023.
  11. Lucente P, Iorizzo M, Pazzaglia M. Contact sensitivity to Tween 80 in a child. Contact Dermatitis. 2000;43(3):172. [PubMed 10985636]
  12. Prevnar 20 (pneumococcal conjugate vaccine [20-valent]) [prescribing information]. Philadelphia, PA: Pfizer; April 2023.
  13. Prevnar 20 (pneumococcal conjugate vaccine [20-valent]) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada ULC; November 2023.
  14. Prymula R, Siegrist CA, Chlibek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. Lancet. 2009;374(9698):1339-1350. doi:10.1016/S0140-6736(09)61208-3 [PubMed 19837254]
  15. Refer to manufacturer's labeling.
  16. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44-e100. doi:10.1093/cid/cit684 [PubMed 24311479]
  17. Shelley WB, Talanin N, Shelley ED. Polysorbate 80 hypersensitivity. Lancet. 1995;345(8980):1312-1313. doi:10.1016/s0140-6736(95)90963-x [PubMed 7746084]
  18. Weinberg A, Muresan P, Laimon L, et al; NICHD P1091 study team. Safety, immunogenicity, and transplacental antibody transport of conjugated and polysaccharide pneumococcal vaccines administered to pregnant women with HIV: a multicentre randomised controlled trial. Lancet HIV. 2021;8(7):e408-e419. doi:10.1016/S2352-3018(20)30339-8 [PubMed 33915104]
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