Centers for Disease Control and Prevention (CDC) Lowers Pneumococcal Vaccination Age to 50

The U.S. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) has lowered the recommended age for pneumococcal vaccination from 65 to 50 years. (1)

The updated guidelines recommend pneumococcal vaccination for the following groups:

• Adults aged 50 years and older who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown.
• Adults aged 19–49 years with underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown.
• Adults aged 19 years and older who began their pneumococcal vaccine series with PCV13 (pneumococcal 13-valent conjugate vaccine) but have not yet completed the recommended doses of PPSV23 (pneumococcal 23-valent polysaccharide vaccine). (1,2)

Potential Reasons for Lowering the Recommended Vaccination Age from 65 to 50 Years: The recommendation to lower the vaccination age from 65 to 50 years is based on the significant burden of pneumococcal disease and the need to protect individuals at an age when the risk of infection substantially increases, in the light of evolving evidence (2,3)

• The post-COVID-19 surge in invasive pneumococcal disease (IPD) cases, with Pneumococcus being the most common co-infection and contributing to 50% of COVID-related deaths, highlights the need for earlier vaccination (3)
• Pneumococcal bacteria can cause severe illnesses such as pneumonia, meningitis, and bloodstream infections, with adults <50 years particularly vulnerable. (4) The high mortality rate of pneumococcal pneumonia, ranging from 14% to 30% overall and up to 50% in ICU patients, combined with the low vaccination coverage in adults over 45 years despite existing recommendations, emphasizes the urgency of preventive measures. (3)
• Most patients with pneumococcal infections have multiple comorbidities, with a record of up to 72.6% of IPD patients having one or more underlying conditions, significantly increasing their risk of severe outcomes. (5)

India has the highest mortality and morbidity due to IPD among adults aged >50 years, with a high burden of pneumococcal disease in this age group, rising comorbidities (6), low life expectancy, and critically low vaccine coverage of 0.6% among adults over 45 years. (7) Despite global recommendations and increasing evidence of vaccine benefits, usage remains suboptimal in India, highlighting the urgent need for preventive measures to protect the at-risk population. (6)

The updated guideline recommendation aligns with the Indian Consensus Guidelines on Adult Immunization released in 2024, a collaborative initiative by the Association of Physicians of India (API) in partnership with 13 medical societies that support the use of pneumococcal vaccines in adults aged 18-49 years with underlying medical conditions (such as diabetes, chronic lung, liver, kidney disease) and all adults aged 50 years and above. The pneumococcal conjugate vaccine (PCV13) should be administered first, followed by the pneumococcal polysaccharide vaccine (PPSV23) after one year for at-risk individuals or eight weeks for those at high risk. (8)

References:

1. U.S. Centers for Disease Control and Prevention.CDC Recommends Lowering the Age for Pneumococcal Vaccination from 65 to 50 Years Old. Accessed on 2nd January 2025 from https://www.cdc.gov/media/releases/2024/s1023-pneumococcal-vaccination.html

2. U.S. Centers for Disease Control and Prevention. Summary of Work Group Interpretations of EtR and Policy Option on PCV21 Use in Adults. Accessed on 2nd January 2025 from https://www.cdc.gov/acip/downloads/slides-2024-06-26-28/04-Pneumococcal-Kobayashi-508.pdf.

3. Koul PA, Vora AC, Jindal SK, et al. Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024). Lung India. 2024;41(4):307-317. doi:10.4103/lungindia.lungindia_8_24

4. Wiedermann U, Visser LG. Routine Adult Vaccines. In: Travel Medicine. 1st ed. Elsevier; 2019:75-87. doi:10.1016/b978-0-323-54696-6.00010-0

5. Hanada S, Takata M, Morozumi M, et al. Multiple comorbidities increase the risk of death from invasive pneumococcal disease under the age of 65 years. J Infect Chemother. 2021;27(9):1311-1318. doi:10.1016/j.jiac.2021.04.018

6. Koul PA, Chaudhari S, Chokhani R, et al. Pneumococcal disease burden from an Indian perspective: Need for its prevention in pulmonology practice. Lung India. 2019;36(3):216-225. doi:10.4103/lungindia.lungindia_497_18

7. Association of Physicians of India. The New Indian Consensus Guideline on Adult Immunization. 2024 Retrieved on 2nd January 2025 from https://www.emvac.in/wp-content/uploads/2024/06/Adult-Vaccination-Booklet.pdf

8. Bendre S, Narayanan V. Pneumococcal vaccination in adults: awareness, recommendations, and coverage. Indian Pract. 2024;75(11): Published November 9, 2024.