ACIP Lowers Pneumococcal Vaccine Age Recommendation to Start at 50

The CDC recommends pneumococcal vaccination for all children under 5 years and adults aged 50 and older, as well as for individuals at increased risk for pneumococcal disease. For the first time, the CDC lowered the recommended age for those who should get a pneumococcal vaccine down to 50, from 65.¹

In the US, two types of pneumococcal vaccines are used: conjugate vaccines (PCVs) and the polysaccharide vaccine (PPSV23). For adults 50 and older, the recommended vaccines are PCV15, PCV20, or PCV21. If PCV15 is administered, a dose of PPSV23 should follow one year later; however, PCV20 or PCV21 does not require additional PPSV23. For adults aged 65 and older, vaccination options can be discussed based on shared clinical decision-making. Additionally, specific risk-based recommendations may apply to children and adults under 65, depending on their vaccination history.¹

The Advisory Committee on Immunization Practices (ACIP) met last week and discussed this potential recommendation for a single dose of pneumococcal conjugate vaccine for PCV-naïve adults 50–64 years. The majority of committee members supported this recommendation, while about 25% expressed opposition. Economic analyses indicated that PCV20 has a higher cost per quality-adjusted life year (QALY) gained compared to PCV21. The committee acknowledged uncertainties regarding the impact of pediatric PCV use and the duration of protection offered by the vaccines. Concerns were raised about the broader implications of recommending a vaccine, particularly the differences in serotype coverage between PCV20 and PCV21. Ultimately, ACIP proposed recommending the pneumococcal conjugate vaccine for all PCV-naïve adults aged 50 years and older.²

Recent Historical Context

On June 17, 2024, the FDA approved the 21-valent pneumococcal conjugate vaccine (PCV21; CAPVAXIVE) for adults aged 18 and older. This new vaccine introduces eight serotypes not included in other licensed pneumococcal vaccines. ACIP recommends PCV for all adults 65 and older, as well as for adults aged 19–64 with specific risk conditions for pneumococcal disease, provided they have not previously received a PCV or their vaccination history is unknown.³

Before the approval of PCV21, adults had the option of receiving either the 20-valent PCV (PCV20; Prevnar20) alone or the 15-valent PCV (PCV15; VAXNEUVANCE) in conjunction with the 23-valent polysaccharide vaccine (PPSV23; Pneumovax23). Additional recommendations exist for adults who began their pneumococcal vaccination series with the 13-valent PCV (PCV13) regarding the use of PCV20.³

To guide its recommendations, the ACIP Pneumococcal Vaccines Work Group employed the Evidence Recommendations framework. On June 27, 2024, ACIP recommended a single dose of PCV21 as an option for adults aged 19 and older for whom pneumococcal vaccination is indicated. Importantly, the indications for pneumococcal vaccination have remained consistent with previous recommendations. This report summarizes the evidence reviewed in support of these recommendations and provides clinical guidance for the use of PCV21 in appropriate patient populations.³

In conclusion, the CDC's decision to lower the pneumococcal vaccination age to 50 expands protection against pneumococcal disease for more adults. With the approval of the PCV21 and clear guidelines for those aged 50 and older, healthcare providers can better address vaccination needs. The ACIP's ongoing discussions emphasize the importance of evidence-based recommendations and the need for further research on vaccine efficacy and coverage differences.

References

1. Pneumococcal Vaccine Recommendations. CDC. October 26, 2024. Accessed October 28, 2024. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html

2. ACIP Presentation Slides: October 23-24, 2024 Meeting. CDC. October 24, 2024. Accessed October 28, 2024. https://www.cdc.gov/acip/meetings/presentation-slides-october-23-24-2024.html

3. Kobayashi M, Leidner AJ, Gierke R, et al. Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep 2024;73:793–798. DOI: http://dx.doi.org/10.15585/mmwr.mm7336a3