ACIP Votes to Lower Recommended Age of Pneumococcal Vaccination

The CDC Advisory Committee on Immunization Practices (ACIP) has voted to lower recommended age for pneumococcal vaccination from 65 years to 50 years of age.¹

Following the announcement, both Merck and Pfizer released statements applauding the ACIP decision.^2,3 Both companies manufacture FDA-approved pneumococcal vaccines. ACIP also recommended that adults aged 19 to 49 years with certain underlying conditions or risk factors who have not received a pneumococcal vaccine, or whose vaccination history is unknown, receive a vaccination. CDC Director Mandy K. Cohen, MD, MPH, endorsed these recommendations.

“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,” said Eliav Barr, senior vice president, head of global clinical development, and chief medical officer at Merck.² “This recommendation is a significant step forward in the efforts to enhance equitable access and may improve vaccination rates.”

In a news release from Pfizer,³ Luis Jodar, PhD, pointed out that expanding the use of Pfizer's pneumococcal vaccine “also provides the opportunity to limit the reemergence of disease-causing strains like serotype 4, which has recently affected certain US adult populations.” Jodar is the senior vice president of vaccines and anti-infectives chief medical affairs officer at Pfizer.

Streptococcus pneumoniae bacteria are responsible for pneumococcal pneumonia; infections are the leading bacterial cause of pneumonia hospitalizations in the US. Additionally, there are approximately 30,000 cases of, and 3000 deaths related to, invasive pneumococcal disease each year.^4,5

READ MORE: At Higher Risk, Vaccine Efficacy, Uptake Are Crucial for Older Adult Populations | IDWeek 2024

Currently, there are 4 recommended pneumococcal vaccines⁶: PCV21, a pneumococcal 21-valent conjugate vaccine (Capvaxive); PCV15, a pneumococcal 15-valent conjugate vaccine (Vaxneuvance); and PPSV23, a pneumococcal vaccine, polyvalent (Pneumovax 23), all manufactured by Merck; and PCV20, a pneumococcal 20-valent conjugate vaccine (Prevnar 20) manufactured by Pfizer.

Another potential immunization option is currently in development: VAX-31 is a 31-valent pneumococcal conjugate vaccine candidate manufactured by Vaxcyte. In early September, the company reported positive topline data from its phase 1/2 of VAX-31 (NCT06151288), which increases coverage to more than 95% of invasive pneumococcal disease circulating in adults aged 50 years and older in the US.⁷

Capvaxive was approved by the FDA in June 2024⁸ and is indicated for active immunization to prevent invasive disease and pneumonia caused by S pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F and 35B in adults, as well as active immunization for the prevention of pneumonia caused by S pneumoniae serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F and 35B in adults.² Per national-level CDC data from 2018 to 2022, the serotypes covered by Capvaxive “are responsible for more cases of invasive pneumococcal disease in adults compared to PCV20,” the news release from Merck noted. “In adults 50 years of age and older, Capvaxive covers the serotypes responsible for approximately 84% of [invasive pneumococcal disease] cases, compared to approximately 52% covered by PCV20.” The company also noted that there are no current studies comparing the efficacy of Capvaxive and Prevnar 20.²

Prevnar 20 is indicated for the prevention of invasive disease caused by S pneumoniae strains 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals aged 6 weeks and older; the prevention of otitis media caused by 7 of the 20 strains in individuals aged 6 weeks to 5 years of age, and active immunization for the prevention of pneumonia caused by S pneumoniae strains 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in adults. An indication for the prevention of pneumonia caused by S pneumoniae serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F in adults “is approved based on immune response.”³

READ MORE: Immunization Resource Center

References

1. CDC recommends lowering the age for pneumococcal vaccination from 65 to 50 years old. News release. CDC. October 23, 2024. Accessed October 24, 2024. https://www.cdc.gov/media/releases/2024/s1023-pneumococcal-vaccination.html

2. CDC’S ACIP recommends Merck’s Capvaxive (pneumococcal 21-valent conjugate vaccine) for pneumococcal vaccination in adults 50 years of age and older. News release. Merck. October 23, 2024. Accessed October 24, 2024. https://www.merck.com/news/cdcs-acip-recommends-mercks-capvaxive-pneumococcal-21-valent-conjugate-vaccine-for-pneumococcal-vaccination-in-adults-50-years-of-age-and-older/

3. Advisory Committee on Immunization Practices recommends Prevnar 20 (20-valent pneumococcal conjugate vaccine) for adults aged 50 and older. News release. Pfizer. October 23, 2024. Accessed October 24, 2024. https://www.pfizer.com/news/press-release/press-release-detail/advisory-committee-immunization-practices-recommends

4. Pneumococcal disease. National Foundation for Infectious Diseases. Accessed October 24, 2024. https://www.nfid.org/infectious-disease/pneumococcal/

5. Kahn R, Zielinski L, Gedlinske A, et al. Health care provider knowledge and attitudes regarding adult pneumococcal conjugate vaccine recommendations — united states, September 28–October 10, 2022. Morb Mortal Weekly Rep. 2023;72(36);979-984.

6. About pneumococcal vaccines. CDC. Accessed October 24, 2024. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/about-vaccine.html

7. Vaxcyte reports positive topline data from phase 1/2 study of VAX-31, its 31-valent pneumococcal conjugate vaccine candidate, in adults aged 50 and older. News release. Vaxcyte. September 3, 2024. October 24, 2024. https://investors.vaxcyte.com/news-releases/news-release-details/vaxcyte-reports-positive-topline-data-phase-12-study-vax-31-its

8. Biscaldi L. FDA approves pneumococcal 21-valent conjugate vaccine Capvaxive. Drug Topics. June 18, 2024. Accessed October 24, 2024. https://www.drugtopics.com/view/fda-approves-pneumococcal-21-valent-conjugate-vaccine-capvaxive