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Updated: Jan 11, 2026
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Published on: February 15, 2013
Recommendations on PCV20 vaccine in adults and at-risk populations
Giovanni Sotgiu1,2, Mariangela Puci1, Michele Bartoletti3,4
1Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Insights
The 20-valent pneumococcal conjugate vaccine (PCV20) offers expanded protection against pneumococcal disease in adults, including those over 65 and at-risk populations. Current recommendations support PCV20 for primary vaccination and as a booster, demonstrating its efficacy and cost-effectiveness.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- *Streptococcus pneumoniae* is a leading cause of pneumonia, bacteremia, and meningitis in adults, particularly older individuals and those with underlying conditions.
- Pneumococcal vaccines target capsular polysaccharides, with the 20-valent pneumococcal conjugate vaccine (PCV20) introduced in 2021 offering broader serotype coverage than previous vaccines like PCV13 and PCV15.
- PCV20 provides enhanced protection against common serotypes responsible for invasive pneumococcal disease (IPD) and community-acquired pneumonia.
Purpose of the Study:
- To review current global recommendations for pneumococcal vaccination in adults, with a focus on PCV20.
- To evaluate the safety, tolerability, and cost-effectiveness of PCV20 in various populations.
- To summarize the role of PCV20 in preventing pneumococcal infections in adults and at-risk groups.
Main Methods:
- A comprehensive literature search was performed using PubMed, Scopus, and government websites.
- Relevant articles, studies, and vaccination guidelines concerning PCV20 were identified and summarized.
- The review focused on recommendations for adult vaccination, safety profiles, and economic evaluations.
Main Results:
- Recommendations for adults aged 65 and older support a single dose of PCV20.
- A single PCV20 booster is recommended for individuals previously vaccinated with PCV13 or PPSV23.
- PCV20 is also recommended for individuals who have not completed their pneumococcal vaccination schedules and is being incorporated into vaccination programs for high-risk adults and children in several countries.
Conclusions:
- The 20-valent pneumococcal conjugate vaccine (PCV20) is effective, safe, and cost-effective for preventing invasive and non-invasive pneumococcal disease.
- PCV20 is recommended for broad use across different age groups, including adults and individuals with underlying health conditions.
- The vaccine's expanded serotype coverage contributes to improved public health outcomes by reducing the burden of pneumococcal infections.
Introduction:
Streptococcus pneumoniae is a common cause of bacterial pneumonia, bacteraemia and meningitis in adults, especially among older adults and individuals with specific underlying medical conditions. The composition of the capsular polysaccharides distinguishes different pneumococcal serotypes and serves as the target for commercially available vaccines. The 20-valent pneumococcal conjugate vaccine (PCV20) was introduced in 2021, conferring protection to seven additional serotypes over PCV13 and five over PCV15, and, thus, providing increased coverage against common serotypes that cause invasive pneumococcal disease (IPD) and community-acquired pneumonia. The present narrative review summarises current recommendations for pneumococcal vaccination in different countries, focusing on adult and at-risk populations, safety, tolerability, and cost-effectiveness.
Methods:
A comprehensive search of existing literature was conducted on PubMed, Scopus and government websites to gather relevant articles, studies and recommendations about PCV20. The information was summarised to provide an overview.
Results:
The recommendations for adults over 65 years of age support the use of a single dose of PCV20, and a single booster of PCV20 for people who had previously received PCV13 or PPSV23. The administration of PCV20 is also recommended for those who have not completed the vaccine schedules for PCV13 or PPSV23. Several countries have recently included PCV20 in the vaccination of adults and children at higher risk of developing IPD.
Conclusion:
The efficacy, safety and cost-effectiveness of PCV20 support its use in preventing invasive and noninvasive pneumococcal disease across age groups, including those with underlying health conditions.
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