ACIP recommends PCV for adults aged 50 and older

The U.S. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) currently recommends pneumococcal conjugate vaccine (PCV) for all adults age 50 and older who have not yet received PCV. The new recommendation, passed by ACIP members on a 14-1 vote, expands the current age-based recommendation to include children under 5 and adults 65 and older, as well as adults 19 to 64. Also covered. Underlying conditions or risk factors that have not received PCV, and certain adults who have received PCV13 but not PCV20.

This recommendation leaves the choice of PCV to the clinician. The updated language calls for a single dose of PCV (which can be PCV15, PCV20, or PCV21) for all adults aged 50 and older. Adults aged 19 to 64 with underlying health conditions (those already recommended for PCV) can receive the newly approved PCV21 as an option.

This decision was based in part on an economic analysis of PCV use among adults ages 50 to 64 in the United States. Miwako Kobayashi, MD, presented a summary of the pneumococcal vaccine working group's interpretation of the evidence and recommendations at the October 23, 2024 ACIP meeting where the ACIP vote was held.

She said data from the CDC shows that the relative burden of pneumococcal disease among adults ages 50 to 64 is increasing, contributing to the success of pediatric PCV programs.

Health equity was another major factor in the work group's decision to recommend vaccination for adults age 50 and older. “Disparities in pneumococcal vaccination coverage by race and ethnicity exist for both age-based and risk-based indications,” Kobayashi said in his presentation. The working group acknowledged that the overall impact of vaccine recommendations on health equity is complex, but this update will expand vaccination coverage to people with known and unknown risk factors and The majority agreed that providing protection at an earlier age when risk factors are present would improve health equity. He said people are already experiencing increased disease rates.

Regarding safety, the working group concluded that, despite potential signs of Guillain-Barre syndrome, the expected undesirable effects of PCV are minimal, and the CDC and U.S. Food and Drug Administration recommend that We plan to continue monitoring the safety of PCVs.

Support is not universal

A majority of the ACIP Pneumococcal Vaccine Working Group supported the approved option, but agreed that additional doses may be required in the future, working group chair James Lohr, MD, said in an introductory presentation. Ta.

Overall, important uncertainties include the indirect effects of new pediatric pneumococcal vaccines on adults, data on the duration of protection from adult vaccines, and the effects of new high-volume vaccines (some of which are in development) on adults. remains, Lohr said.

The new 21-valent PCV, known as PCV 21, was approved by the FDA in June 2024 for adults 18 years and older, Rohr said. “PCV21 is not PCV20 with one additional serotype,” it said, stressing that it provides additional protection. The working group considered models including PCV21 and the existing PCV20. However, the majority of the working group agreed that making age-based recommendations based on vaccine products would be more difficult to implement and that insurance coverage could be a factor given the recent approval of PCV21. Agreed. Therefore, the proposals submitted to ACIP as a whole were not about specific PCVs.

Notably, Mr. Lohr, who was tasked with moving a motion in favor of this recommendation as chair of the working group, strongly emphasized that only the PCV21 vaccine is necessary for older adults without a history of vaccination. He said he voted against it as a voting member because of his opinion. Over 50 years old. “I think PCV21 is a better vaccine because it targets more serotypes,” he said during the discussion. Data presented at the February 2024 ACIP meeting showed >80% coverage of PCV21 vs. PCV20 invasive pneumococcal disease in adults 65 years and older and adults 19 to 64 years with risk-based indications. or less than 60%, Loehr said. Said.