The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) expanded its pneumococcal conjugate vaccine recommendations to include all adults aged 50 or older, regardless of vaccination history or risk factors, according to updated guidance.
The recommendations went into effect on October 23, 2024, and represent updated guidance from previous recommendations for adults aged 65 and older or those aged 19 to 64 with specific risk conditions.
"The updated, expanded age-based recommendation is expected to improve pneumococcal disease prevention in adults aged 50 to 64 years, particularly among demographic groups experiencing higher disease rates," the guidance states.
The recommendation applies to all pneumococcal conjugate vaccine (PCV)-naive adults or those with unknown vaccination history and offers three vaccine options: PCV21 (CAPVAXIVE), PCV20 (Prevnar20), or PCV15 (VAXNEUVANCE). For individuals receiving PCV15, an additional dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) should be administered at least one year later. In cases of immunocompromised adults, PPSV23 may be administered as soon as eight weeks after PCV15.
The decision was driven by key epidemiological findings. Prior to the COVID-19 pandemic, approximately 30,000 cases of invasive pneumococcal disease (IPD) occurred annually among U.S. adults. In 2022, IPD incidence and mortality rates for adults aged 50-64 years were 13.2 and 1.8 per 100,000 population, respectively.
Racial disparities in disease burden also influenced the recommendation. Data from CDC's Active Bacterial Core surveillance revealed that IPD rates among Black adults peaked earlier (ages 55 to 59) compared to non-Black adults, and non-PCV13 serotype IPD rates among American Indian/Alaska Native and Black adults (25 and 10 per 100,000 population, respectively) were significantly higher than the population average of six per 100,000.
Economic analyses supported feasibility, with the Tulane-CDC model estimating costs of $131,023 to $214,430 per quality-adjusted life-year (QALY) gained for PCV21 and $251,037 to $546,811 for PCV20. Safety data from the Vaccine Adverse Event Reporting System showed a low rate of Guillain-Barré syndrome (0.7 cases per million doses) following PCV20 administration.
The guidance maintains risk-based recommendations for adults aged 19 to 49 and emphasizes shared clinical decision-making for certain populations, including those who completed both PCV13 and PPSV23 at age 65 or older.
ACIP will continue monitoring vaccine effectiveness, safety, and the potential need for booster doses. For implementation details, vaccination providers are directed to consult vaccine package inserts for specific precautions, warnings, and contraindications.