Reconsidering Guidelines on the Use of Pneumococcal Vaccines in Adults 65 Years or Older

The recent adult pneumococcal vaccine recommendations issued by the Advisory Committee on Immunization Practices (ACIP) and endorsed by the Centers for Disease Control and Prevention are well intentioned but misguided, complex, and not ready for widespread adoption.¹

In August 2014, the ACIP¹ recommended the newer pneumococcal conjugate vaccine 13 (PCV13) ($152 per dose²) for adults 65 years or older followed 6 to 12 months later by the older pneumococcal polysaccharide vaccine 23 (PPSV23) ($72 per dose²) (Box). The PCV13 covers 12 of 23 pneumococcal serotypes in PPSV23 plus an additional serotype, and contains conjugate protein, which renders a more robust immune response in individuals with immature or impaired immune systems. In the United States, the conjugate vaccine has been recommended for several years for young children and for patients who are immunocompromised.