This transcript has been edited for clarity.
Today I will discuss the new recommendations for pneumococcal vaccination in adults. First we’ll make it easy and straightforward, and then we’ll get a little more complicated. The recommendations come from the Advisory Committee on Immunization Practices (ACIP) and were published in the CDC MMWR.
Big new recommendation: All adults aged 50 or older who have not received pneumococcal vaccination or whose immunization status is unknown should receive a single dose of a pneumococcal conjugate vaccine (PCV).
Adults aged 19-49 who have underlying conditions that increase their risk for pneumococcal disease also should receive PCV.
Conditions that increase the risk for pneumococcal disease include alcoholism; cerebrospinal fluid leak; chronic heart, liver, or lung disease; chronic renal failure; cigarette smoking; cochlear implant; congenital or acquired asplenia; diabetes mellitus; generalized malignancy; HIV; Hodgkin disease; immunodeficiency; iatrogenic immunosuppression; leukemia, lymphoma, or multiple myeloma; nephrotic syndrome; solid organ transplant; or sickle cell disease or other hemoglobinopathies. That’s a long list, so let me repeat the ones that we see most commonly that might not be obvious: alcoholism, asthma and chronic obstructive pulmonary disease, cigarette use, and diabetes.
I also want to point out the language here: “ All adults aged 50 or older who have not received pneumococcal vaccination or whose immunization status is unknown should receive a single dose of a pneumococcal conjugate vaccine (PCV).” Notice the phrase “whose immunization status is unknown.” That means don’t fret if someone is in an eligible group and you don’t know for certain whether they received pneumococcal vaccine in the past; if you don’t know, just go ahead and give them the shot.
Options for pneumococcal conjugate vaccine include a few choices:
- PCV 21 (Capvaxive) (Merck)
- PCV 20 (Prevnar20) (Wyeth)
- PCV 15 (Vaxneuvance) (Merck), followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23) (Merck)
Patients might ask about how these different vaccines compare. I’ll point out the important differences. PCV21 contains eight pneumococcal serotypes that are not included in the other pneumococcal vaccines, but it does not contain certain pneumococcal serotypes that are contained in other pneumococcal vaccines. One of those serotypes is serotype 4.
In most US geographic areas, PCV 21 is expected to cover more circulating pneumococcal strains than PCV 20 or PCV 15. Of note, this is not true everywhere, specifically in geographic locales where serotype 4 cases are frequently seen among adults aged < 65 years who have underlying conditions. The CDC recommends that when the prevalence of pneumococcal serotype 4 exceeds 30%, then PCV 20, or PCV 15 and PPSV 23, may provide broader coverage against the locally circulating strains of pneumococcal bacteria. The areas of the country where more than 30% of circulating strains are made up of serotype 4 include Alaska, Colorado, Navajo Nation, New Mexico, and Oregon.
Let me go over a limited number of additional circumstances. If an eligible adult received PPSV23 (Pneumovax23) previously, they should receive a single dose of PCV 21, PCV 20, or PCV 15 at least 1 year after the last PPSV23 dose. For a limited number of other scenarios we have explicit guidance in the MMWR. When there is a question, I find it helpful to look up the CDC guidance either on the web at PneumoRecs – VaxAdvisor or on their easy-to-use app, available for either iOS devices or Android devices.
Why did they change the recommendations? About 30%-50% of adults aged 50-64 years have one or more risk conditions that qualify for risk-based pneumococcal vaccination, but we are not very good at following risk-based preventive recommendations. Under the previous recommendations, only a third of high-risk individuals received a pneumococcal vaccine. For the age group (> 65) for whom blanket coverage is recommended, the uptake is twice as high. Blanket recommendations lead to better coverage. In addition, invasive pneumococcal disease peaks at a younger age, 55-59 years old, in Black adults compared with rates among non-Black adults. The shift to recommending pneumococcal vaccine for all adults over age 50 should increase vaccination rates for those at highest risk and should reduce disparities of care. Safety data show PCV to be very safe. Postlicensure data indicate that with PCV 20 there may be a small increase in Guillain-Barré syndrome (less than 1 in a million doses), although the data here are uncertain.
COMMENTARY
New Pneumococcal Vaccine Recommendations: What You Should Know
DISCLOSURES
| March 05, 2025This transcript has been edited for clarity.
Today I will discuss the new recommendations for pneumococcal vaccination in adults. First we’ll make it easy and straightforward, and then we’ll get a little more complicated. The recommendations come from the Advisory Committee on Immunization Practices (ACIP) and were published in the CDC MMWR.
Big new recommendation: All adults aged 50 or older who have not received pneumococcal vaccination or whose immunization status is unknown should receive a single dose of a pneumococcal conjugate vaccine (PCV).
Adults aged 19-49 who have underlying conditions that increase their risk for pneumococcal disease also should receive PCV.
Conditions that increase the risk for pneumococcal disease include alcoholism; cerebrospinal fluid leak; chronic heart, liver, or lung disease; chronic renal failure; cigarette smoking; cochlear implant; congenital or acquired asplenia; diabetes mellitus; generalized malignancy; HIV; Hodgkin disease; immunodeficiency; iatrogenic immunosuppression; leukemia, lymphoma, or multiple myeloma; nephrotic syndrome; solid organ transplant; or sickle cell disease or other hemoglobinopathies. That’s a long list, so let me repeat the ones that we see most commonly that might not be obvious: alcoholism, asthma and chronic obstructive pulmonary disease, cigarette use, and diabetes.
I also want to point out the language here: “ All adults aged 50 or older who have not received pneumococcal vaccination or whose immunization status is unknown should receive a single dose of a pneumococcal conjugate vaccine (PCV).” Notice the phrase “whose immunization status is unknown.” That means don’t fret if someone is in an eligible group and you don’t know for certain whether they received pneumococcal vaccine in the past; if you don’t know, just go ahead and give them the shot.
Options for pneumococcal conjugate vaccine include a few choices:
Patients might ask about how these different vaccines compare. I’ll point out the important differences. PCV21 contains eight pneumococcal serotypes that are not included in the other pneumococcal vaccines, but it does not contain certain pneumococcal serotypes that are contained in other pneumococcal vaccines. One of those serotypes is serotype 4.
In most US geographic areas, PCV 21 is expected to cover more circulating pneumococcal strains than PCV 20 or PCV 15. Of note, this is not true everywhere, specifically in geographic locales where serotype 4 cases are frequently seen among adults aged < 65 years who have underlying conditions. The CDC recommends that when the prevalence of pneumococcal serotype 4 exceeds 30%, then PCV 20, or PCV 15 and PPSV 23, may provide broader coverage against the locally circulating strains of pneumococcal bacteria. The areas of the country where more than 30% of circulating strains are made up of serotype 4 include Alaska, Colorado, Navajo Nation, New Mexico, and Oregon.
Let me go over a limited number of additional circumstances. If an eligible adult received PPSV23 (Pneumovax23) previously, they should receive a single dose of PCV 21, PCV 20, or PCV 15 at least 1 year after the last PPSV23 dose. For a limited number of other scenarios we have explicit guidance in the MMWR. When there is a question, I find it helpful to look up the CDC guidance either on the web at PneumoRecs – VaxAdvisor or on their easy-to-use app, available for either iOS devices or Android devices.
Why did they change the recommendations? About 30%-50% of adults aged 50-64 years have one or more risk conditions that qualify for risk-based pneumococcal vaccination, but we are not very good at following risk-based preventive recommendations. Under the previous recommendations, only a third of high-risk individuals received a pneumococcal vaccine. For the age group (> 65) for whom blanket coverage is recommended, the uptake is twice as high. Blanket recommendations lead to better coverage. In addition, invasive pneumococcal disease peaks at a younger age, 55-59 years old, in Black adults compared with rates among non-Black adults. The shift to recommending pneumococcal vaccine for all adults over age 50 should increase vaccination rates for those at highest risk and should reduce disparities of care. Safety data show PCV to be very safe. Postlicensure data indicate that with PCV 20 there may be a small increase in Guillain-Barré syndrome (less than 1 in a million doses), although the data here are uncertain.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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