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News From the Centers for Disease Control and Prevention
January 14, 2020

Pneumococcal Vaccine Recommendation

JAMA. 2020;323(2):112. doi:10.1001/jama.2019.20494

An updated recommendation from CDC’s Advisory Committee on Immunization Practices (ACIP) suggests adults aged 65 years or older should receive only the 23-valent pneumococcal polysaccharide vaccine (PPSV23) with a few exceptions.

In 2014, the ACIP recommended that older adults receive the 13-valent pneumococcal conjugate vaccine (PCV13) first, then the PPSV23 at least a year later. Since then, widespread childhood vaccination with PCV13 and its predecessor the 7-valent pneumococcal conjugate vaccine have “led to sharp declines in pneumococcal disease among unvaccinated children and adults,” according to the ACIP’s review of the evidence. Based on that review, the ACIP voted to remove the recommendation for routine use of PCV13 followed by PPSV23 in this population.

“Incidence of PCV13-type disease has been reduced to historically low levels among adults aged ≥65 years through indirect effects from pediatric PCV13 use,” the authors wrote.

Adults aged 19 years or older with an immunocompromising condition, cerebral spinal fluid leak, or cochlear implant should continue to receive both vaccines, the ACIP recommends. Some adults aged 65 years or older may have a greater risk of exposure to strains of Streptococcus pneumoniae covered by the PCV13 vaccine: those living in nursing homes or long-term care facilities, people living in areas with low rates of pediatric vaccination with PCV13, or those traveling to areas with no childhood PCV13 vaccination program. Certain underlying medical conditions may also increase patients’ risk of developing pneumococcal disease. The ACIP recommends that physicians engage in shared decision-making with such at-risk patients to decide whether they should continue to receive PCV13 followed by PPSV23 at least 1 year later.

“ACIP will continue to review relevant data as they become available and update pneumococcal vaccination policy as appropriate,” the authors wrote.