ACIP Supports Lowering Age for Pneumococcal Vaccination to 50 from 65 Years

The Advisory Committee on Immunization practices (ACIP) of the CDC voted on Wednesday to lower the recommended age for vaccination against invasive pneumococcal disease (IPD) and pneumococcal pneumonia from age 65 to age 50 years, recommending that all adults aged 50 and older receive either Prevnar 20 (20-valent pneumococcal conjugate vaccine; Pfizer) or Capaxvie (pneumococcal 21-valent conjugate vaccine; Merck) to prevent the bacterial infection.¹

_{©Centers for Disease Control and Prevention}

The ACIP vote to update the adult age-based vaccination guidelines was nearly unanimous, with members voting 14 to 1 in favor of earlier initiation of the immunization. CDC Director Mandy Cohen subsequently endorsed the recommendation.¹

Merck’s 21-valent conjugate vaccine won FDA approval for use in adults in June of this year. Approval was followed by an ACIP recommendation for administration to adults aged 65 years and older and also to those between ages 19 and 64 with underlying medical conditions or other risk factors that increase their susceptibility to pneumococcal infection. PCV21 includes 8 serotypes not covered by PCV20, which at the time of the shot’s approval led the ACIP to also recommend the vaccine be used in adults aged 19 years and older who have begun the series of pneumococcal shots with PCV13 (Prenvar 13) but have not received all recommended doses of PPSV23 (Pneumovax 23).2

The 8 unique serotypes covered by the Merck vaccine (15A, 15C, 16F, 23A, 23B, 24F, 31 and 35B) were responsible for approximately 27% of IPD cases in adult aged 50 years and older and approximately 31% in those aged 65 and older, according to data from the CDC. National level CDC surveillance data has also shown that in adults aged 50 years and older, PCV21 covers serotypes that cause more than 8 in 10 (84%) cases of IPD. According to Merck, that compares with 52% covered by Pfizer’s PCV20.2

The Pfizer PCV20 vaccine was first approved for adults in 2021 and recommended by the ACIP for adults in the older age category, 65 years and older. Like the next generation PCV21, it was also endorsed for use in high-risk adults aged 19 to 64 years.3

It is important to note that there are no studies currently that compare the efficacy of the 2 vaccines.

“The CDC’s decision to lower the age-based vaccination recommendations to begin at age 50 has the potential to be a practice-changing milestone,” Eliav Barr, senior vice president, head of global clinical development and chief medical officer, Merck Research Laboratories, said in a company statement. The recommendation “is a significant step forward in efforts to enhance equitable access and may improve vaccination rates,” Barr added.4

“PREVNAR 20 offers protection against the serotypes responsible for the majority of invasive pneumococcal disease cases in this age group. Expanding its use also provides an opportunity to limit the re-emergence of disease-causing strains like serotype 4, which has recently affected certain U.S. adult populations and is covered by the vaccine” Luis Jodar, PhD, Pfizer senior vice president, vaccines and anti-infectives chief medical affairs officer, said in a company news release.