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The 20-valent pneumococcal conjugate vaccine (PCV20), marketed as Prevnar 20, is a sterile suspension of capsular polysaccharides from 20 different serotypes of *Streptococcus pneumoniae* (1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F). Each polysaccharide is individually conjugated to a non-toxic diphtheria toxin mutant carrier protein, CRM197, to enhance immunogenicity by inducing a T-cell dependent immune response. This mechanism leads to the production of high-affinity antibodies and the establishment of immunological memory, providing protection against invasive pneumococcal disease and pneumonia. Developed by Pfizer, PCV20 is indicated for active immunization in both pediatric and adult populations. In the context of the University of Sao Paulo General Hospital, it is being studied in a Phase 4 trial to determine if temporary discontinuation of methotrexate can improve vaccine response in patients with autoimmune rheumatic diseases.
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