CDC: PCV13 No Longer Recommended for All Older Adults

The Centers for Disease Control and Prevention (CDC) have released updated recommendations regarding the use of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) among adults aged 65 years and older.

The new recommendation serves as an update to the 2014 guidance from the Advisory Committee on Immunization Practices (ACIP) which recommended that all adults aged 65 years and older receive both the PCV13 and PPSV23 vaccines.

The 2014 recommendation was expected to be reevaluated, as the ACIP expected that the use of PCV13 in children would reduce the burden of disease among adults. In June of 2019, following a review of available evidence from the previous 3 years which showed that, although PCV-13-type IPD in older adults declined 9-fold during 2000-2014, minimal changes in the incidence of pneumococcal disease among adults were observed.

“Incidence of PCV13-type disease has been reduced to historically low levels among adults aged ≥65 years through indirect effects from pediatric PCV13 use. Implementation of a PCV13 recommendation for all adults aged ≥65 years in 2014 has had minimal impact on PCV13-type disease at the population level in this age group,” they wrote.

“However, PCV13 is a safe and effective vaccine that can reduce the risk for PCV13-type invasive pneumococcal disease and noninvasive pneumonia among persons aged ≥65 years. Balancing this evidence and considering acceptability and feasibility concerns, in June 2019 ACIP voted to no longer routinely recommend PCV13 for all adults aged ≥65 years and instead, to recommend PCV13 based on shared clinical decision-making for adults aged ≥65 years who do not have an immunocompromising condition, CSF leak, or cochlear implant.”

—Michael Potts

Reference:

Matanock A, Lee G, Gierke R, et al; ACIP Pneumococcal Vaccines Work Group. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:1069–1075. http://dx.doi.org/10.15585/mmwr.mm6846a5external.