Pneumococcal Conjugate Vaccine Selection

Geographic-Based Decision Algorithm

• In the Midwestern, Eastern, and Southern United States, PCV20 is the preferred choice due to its broader serotype coverage, including serotype 4, which PCV21 lacks 1, 2, 3
• In locations where serotype 4 invasive pneumococcal disease (IPD) is less than 30%, PCV20 alone or PCV15 + PPSV23 are expected to provide superior protection 1, 3
• In Alaska, Colorado, Navajo Nation, New Mexico, and Oregon, PCV21 is preferred due to high percentages of IPD caused by serotype 4 3, 4, 5

Key Serotype Coverage Differences

• PCV21 lacks serotype 4, which is present in PCV20, making PCV20 a better option in most U.S. regions 4, 6, 5, 7
• In non-Western regions, serotype 4 IPD typically occurs in adults under 65 years with specific risk factors, making PCV20 particularly valuable 1, 2, 3

General Recommendations for All Locations

• The Centers for Disease Control and Prevention (CDC) recommends both PCV20 and PCV21 as options for adults 19 years and older who are recommended to receive pneumococcal conjugate vaccine 2, 3
• A single dose of PCV20 or PCV21 completes the vaccination series with no additional doses needed 8, 9

Clinical Pitfalls to Avoid

• The CDC advises against assuming PCV21 is automatically superior due to its additional serotypes, as the absence of serotype 4 is clinically significant in most U.S. regions 1, 2, 3
• Vaccination needs should be reassessed at age 65 for adults who received pneumococcal vaccines before this age 10, 4, 11