What You Need to Know About the Prevnar 20 Pneumococcal Vaccine

Staying up to date on vaccines can help keep you and your family healthy. Many vaccines are widely recommended by public health experts, and pneumococcal vaccines are no exception.

One of these vaccines is Prevnar 20 (Pneumococcal 20-valent Conjugate Vaccine, or PCV20). It’s a newer vaccine that helps prevent infections caused by 20 types of the bacteria Streptococcus pneumoniae. Infections such as pneumonia, meningitis, and ear infections can often be attributed to this bacteria. Prevnar 20 is FDA approved to protect infants, kids, and adults against pneumococcal disease.

However, four different pneumococcal vaccines are available in the U.S. Prevnar 20 is one go-to option, but other ones may be better choices in certain cases.

What is pneumococcal disease?

Pneumococcal disease is an infection caused by Streptococcus pneumoniae. This bacteria — commonly referred to as “pneumococcus” — is a common cause of pneumonia. Pneumonia is a lung infection that can be caused by many bacteria, viruses, or fungi. But pneumococcus is the most common culprit.

Pneumococcal pneumonia can be life-threatening. But pneumonia isn't the only risk. Pneumococcus can infect other parts of the body too and cause "invasive” conditions like meningitis (bacteria in the brain and spinal cord). It can also cause sinus and ear infections.

What are pneumococcal vaccines?

Pneumococcal vaccines help protect against pneumococcal diseases. There are four pneumococcal vaccines available in the U.S.:

• PCV13 (Prevnar 13)

• PCV15 (Vaxneuvance)

• PCV20 (Prevnar 20)

• PPSV23 (Pneumovax 23)

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The CDC recommends pneumococcal vaccination for all kids under 2 years old and all adults who are at least 65 years old. Although pneumococcal disease can affect people of all ages, younger kids and older adults are most at risk.

Some other people may also need pneumococcal vaccination. For example, adults 19 to 64 years old living with diabetes or lung disease may need vaccination.

Good to know: The vaccines above fall into two categories: conjugate (Prevnar 13, Vaxneuvance, Prevnar 20) and polysaccharide (Pneumovax 23) vaccines. Conjugate vaccines combine a specific protein with a substance that helps the body produce an immune response. Polysaccharide vaccines contain long chains of sugar molecules that mimic the surface of bacteria.

What is Prevnar 20?

Prevnar 20 is a vaccine that prevents pneumonia and other infections caused by 20 strains of pneumococcus. If any of these strains enter your body after receiving the vaccine, your immune system is ready to spring into action and fight it off before it causes a serious infection.

This vaccine has been FDA approved to prevent pneumococcal disease since June 2021. It can be given to adults, as well as children and infants. For adults, Prevnar 20 is a single intramuscular (IM) injection. For young kids, it’s given as 4 separate IM injections.

Who should get Prevnar 20?

Prevnar 20 is recommended for all adults ages 65 years and older who haven’t already received a pneumococcal conjugate vaccine. It’s also recommended in some adults ages 19 to 64 years old with certain medical conditions or other risk factors.

What’s more, Prevnar 20 can be given to infants and kids ages 2 to 23 months old as a 4-dose series. It’s administered at ages:

• 2 months

• 4 months

• 6 months

• 12 to 15 months

Older children can get it too. Kids ages 2 to 18 years old with certain medical conditions can receive one dose of Prevnar 20.

Who shouldn’t get Prevnar 20?

People who’ve had a severe allergic reaction (anaphylaxis) to any of the vaccine’s ingredients shouldn’t receive Prevnar 20. And if you’ve had a prior severe allergic reaction to any vaccines containing the diphtheria toxoid, you should also avoid Prevnar 20. This includes the following vaccines:

• Diphtheria and tetanus (DT and Td)

• Diphtheria, tetanus, and pertussis (DTaP)

• Tetanus, diphtheria, and pertussis (Tdap)

• DTaP and polio vaccine

Prevnar 20 hasn’t been studied in women who are pregnant or breastfeeding. So we don’t know if it’s safe for this group. If you’re unsure if you should receive Prevnar 20, talk to your healthcare provider or pharmacist.

Prevnar 20 side effects

Prior to its approval, Prevnar 20 was studied in several clinical trials for adults, kids, and infants. Across these studies, reported side effects were similar for all ages. These side effects were usually mild, too.

Common Prevnar 20 side effects can be broken down by age group, as detailed in the table below.

Good to know: In initial studies, no notable safety differences were seen between Prevnar 20 and the other pneumococcal vaccines.

Prevnar 20 vs. Pneumovax 23

Pneumovax 23 works differently than Prevnar 20. It protects against 23 different strains of pneumococcus. Nineteen of these strains are found in Prevnar 20. It’s also a polysaccharide vaccine — not a conjugate vaccine.

Pneumovax 23 can be given to the following people:

• Kids and adolescents ages 2 to 18 years and older with certain medical conditions

• Adults ages 65 years and older who have received Prevnar 13 or Vaxneuvance

Prevnar 20 vs. Pneumovax 23 side effects

Like Prevnar 20, the most common side effects of Pneumovax 23 are injection site pain, soreness, and tenderness. It can also cause a headache, tiredness, and muscle pain.

​​Rare but serious side effects have also been reported for Pneumovax 23. Chest pain and heart failure are a couple of examples. However, it’s not certain if these side effects were due to the vaccine specifically.

Prevnar 20 vs. Pneumovax 23 effectiveness

No vaccine is 100% effective at preventing disease, but all pneumococcal vaccines are considered safe and effective for helping protect against pneumococcal disease.

One dose of Pneumovax 23 protects about 60% to 70% of healthy adults against invasive pneumococcal disease. Prevnar 20 is thought to provide better protection for the strains it covers than Pneumovax 23. And its effects may last longer — Pneumovax 23’s effects only last about 5 to 6 years.

Prevnar 20 vs. Prevnar 13

Prevnar 20 and Prevnar 13 work similarly to protect against pneumococcal disease. But Prevnar 13 protects against 13 strains of pneumococcus, whereas Prevnar 20 protects against 20 strains. Pfizer, Prevnar’s manufacturer, states that the 7 additional strains in Prevnar 20 account for roughly 40% of all U.S. pneumococcal disease cases and deaths.

Having different vaccine options available is a plus. Four doses of Prevnar 13 or Prevnar 20 are recommended for all children under 2 years old. Vaxneuvance is another CDC-recommended option for this age group. Kids and adolescents older than 2 years old with certain health conditions may also benefit from these vaccines.

However, as with Pneumovax 23, only Prevnar 20 and Vaxneuvance are recommended pneumococcal vaccines for adults. Prevnar 13 is no longer widely used for this age group.

Prevnar 20 vs. Prevnar 13 side effects

Prevnar 13’s side effects in adults are similar to those caused by Prevnar 20. This includes injection site redness and swelling, tiredness, and headache.

In children under 2 years old, Prevnar 13 most commonly causes irritability, a lowered appetite, and changes in sleep patterns. These same side effects occurred in children between 5 to 17 years old, but to a lesser degree.

Serious side effects are rarely seen with Prevnar 13. Lower respiratory infection, gastroenteritis (stomach infection), and pneumonia are the most common ones. But they occurred in 1% or less of children who received Prevnar 13.

Prevnar 20 vs. Prevnar 13 effectiveness

Studies show that Prevnar 20 produces a similar immune response as Prevnar 13 in adults. It also produces a strong immune response in infants. However, in general, Prevnar 20 is recommended for adults over Prevnar 13. Prevnar 20 offers protection against 7 more pneumococcal strains.

How to save on Prevnar 20

Since Prevnar 20 is now common for older adults, Medicare has started covering the bill. If you have Medicaid, check with your state Medicaid agency to see which vaccines are offered.

What’s more, all Health Insurance Marketplace plans — and many private plans — cover pneumococcal vaccines when provided by an in-network provider. But costs can vary depending on the specific insurance plan.

For people without insurance or adequate coverage, GoodRx can help you save. Prevnar 20 at certain pharmacies is as low as $279.99 with a free GoodRx discount.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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