ACIP Publishes Final Pneumococcal Vaccine Recommendations
These recommendations were voted on at the October 2024 Advisory Committee on Immunization Practices meeting.
The CDC’s Advisory Committee on Immunization Practices (ACIP) has published finalized pneumococcal vaccine recommendations, following a change to recommended guidelines at the October 2024 ACIP meeting.
These finalized recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).1
Pneumococcal vaccine recommendations were voted on at the October 2024 Advisory Committee on Immunization Practices meeting. | Image credit: Tatiana Shepeleva - stock.adobe.com
Prior to October 2024, ACIP recommended a single dose of a pneumococcal conjugate vaccine (PCV) for 2 groups of patients: adults aged 19 to 64 years with high risk of pneumococcal vaccine, and all adults aged 65 years or older. Recommended vaccines included the 20- or 21-valent PCV (Prevnar, Capvaxive) alone or the 15-valent PCV (PCV15) in a series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23). Additional guidelines were available for vaccination of patients who began their pneumococcal vaccine series with the 13-valent PCV (Prevnar13).
ACIP committee members recommended PCV21 as an option for adults at their June 2024 meeting. Between July and October 2024, the ACIP Pneumococcal Vaccines Work Group “considered PCV use among PCV-naïve adults” aged 60 to 64 years within the Evidence to Recommendations Framework. The Work Group also reviewed both published and unpublished pneumococcal disease incidence and mortality data, pneumococcal vaccination coverage, and “economic models of age-based PCV use at age ≥50.”
It is estimated that pneumococcal pneumonia, caused by Streptococcus pneumoniae is responsible for 12% to 13% of all pneumonia hospitalizations, or roughly 225,000 adult hospitalizations each year. Approximately 90% of adults aged 50 to 64 years with invasive pneumococcal disease who were hospitalized with pneumococcal pneumonia had at least 1 or more risk factor for the disease. Incidence rates increased during the COVID-19 pandemic, with invasive pneumococcal disease incidence and mortality rates of 13.2 and 1.8 per 100,000 population, respectively, “higher than those in all other age groups except adults aged [65 years or older],” the study authors noted.
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Overall, an estimated 32% to 54% of adults aged 50 to 64 years had at least 1 condition qualifying them for risk-based pneumococcal vaccination. But, evaluation of 2022 Behavioral Risk Factor Surveillance System data indicated that only 37% of adults with a risk-based vaccination recommendation were vaccinated (vs 70% with an age-based recommendation).
These data also indicated that “racial disparities in vaccination rates were apparent.” Among Black adults, invasive pneumococcal disease rates peaked at a younger age—between 55 and 59 years vs non-Black adults—and increased with age. Many of these racial disparities are driven by non-PCV13 serotypes.
Economic models from Tulane-CDC and Merck were used to evaluate cost effectiveness of PCV20 and PCV21 vaccines in PCV-naïve adults aged 50 to 64 years, while a model from Pfizer evaluated cost effectiveness of PCV20 only. All 3 models used quality-adjusted life-years (QALY) as the primary health outcome.
According to the Tulane-CDC model, estimated costs per QALY were $131,023 to $214-420 for PCV21 and $251,037 to $546,811 for PCV20, while the Merck model estimated costs per QALY were $$251,048 to $425,455 for PCV21 and $548,114 to $879,117 for PCV20. According to Pfizer, estimated costs per QALY with PCV20 were $56,376–$133,524.
The new ACIP guidelines recommend PCV vaccination for all PCV-naïve adults aged 50 years and older; recommendations for adults aged 19 to 49 years with a risk condition, as well as for adults who previously received PCV13, are unchanged. When selecting a vaccine, PCV21 “is expected to cover more circulating pneumococcal strains” than other recommended PCVs. However, in some populations, more than 30% of pneumococcal disease is due to serotype 4, which is covered with PCV20 alone or PCV15 and a PPSV23 series.
Adults aged 19 years and older who started their pneumococcal vaccination series with PCV13 but have not received all recommended doses should receive either PCV20 or PCV21 to complete the series. PPSV23 is no longer recommended.
The pneumococcal vaccine may be administered with other age-appropriate vaccines at the same visits for adults with no contraindications to vaccination.
READ MORE: Immunization Resource Center
