Pneumococcal Vaccination at 50 Years Old Can Improve Outcomes

Pneumococcal vaccination beginning at age 50 years, rather than age 65 years, shows the potential to boost health benefits, according to a study published in the American Journal of Preventive Medicine.¹ Despite an improvement in health outcomes from the 21-valent pneumococcal conjugate vaccine (PCV21), lowering the age recommendation from 65 to 50 years comes with increased health care costs.

“Lowering the age for pneumococcal vaccination gives more adults the opportunity to protect themselves from pneumococcal disease at the age when risk of infection substantially increases,” wrote the CDC.² “Pneumococcal bacteria can cause serious illnesses, including pneumonia, meningitis, and bloodstream infections, and older adults are at increased risk for pneumococcal disease.”

The research evaluates 2 primary implementation methods: a moving strategy and an adding strategy. The moving strategy involves shifting the single-dose, age-based recommendation from age 65 to age 50 years.¹

Although this approach reduces the disease burden for those in the 50-to-64-year age range, it may inadvertently increase the burden for those over 65 years because vaccine effectiveness typically declines linearly to zero over a period of 15 to 20 years.

READ MORE: Patient-Focused Strategies Are Most Effective for Boosting Pneumococcal Vaccination

In contrast, the adding strategy, which provides a dose at age 50 years followed by a second dose at age 65 years, improves health outcomes across all age groups but necessitates higher total costs.¹

For pharmacists, the clinical choice between vaccines is increasingly complex and must be individualized based on serotype coverage and patient history. PCV21 was specifically developed to target serotypes that commonly cause disease in adults, covering 81% of circulating disease compared with only 58% for PCV20.^1,3

Economic evaluations of the 50-to-64-year age group show that PCV21 is a more effective and economically favorable option, with an incremental cost-effectiveness ratio of $73,000 per quality-adjusted life year (QALY) gained. According to an article published in Vaccine, this is significantly lower than the $820,000 per QALY estimated for an age-based strategy using PCV20 in the same population.⁴

Despite the broad benefits of PCV21, local epidemiology remains a vital factor for pharmacy practice. PCV21 does not contain serotype 4, a strain that is particularly prevalent in the Western US and among unhoused populations.³

In geographic areas where serotype 4 causes more than 30% of pneumococcal disease, PCV20 is expected to prevent more disease and be more cost-effective than PCV21. This highlights the necessity for pharmacists to understand local serotype prevalence when making clinical recommendations.^1,3,5

The evolving landscape of pneumococcal immunization also includes 15-valent (PCV15) and 20-valent (PCV20) vaccines, as well as the polysaccharide PPSV23. CDC guidance now specifies that if PCV15 is used, it should be followed by a dose of PPSV23 one year later to complete the series.^3,6

However, a single dose of either PCV20 or PCV21 is considered a complete vaccination for adults 50 and older. To navigate these changing schedules, the CDC recommends using the PneumoRecs VaxAdvisor app to provide patient-specific guidance.⁶

By lowering the vaccination age, the CDC aims to address the high proportion of adults aged 50 to 64 who already have risk-based indications but were not previously vaccinated. Pharmacists serve as the lead conductors in this effort, providing the expertise needed to simplify schedules and ensure patients receive the most protective vaccine for their specific risks.^1,3

Although earlier vaccination increases upfront costs, the significant reduction in invasive pneumococcal disease and pneumonia cases represents a major step forward for adult public health.^1,4

“In this model, transitioning to an age-based pneumococcal vaccination strategy for adults aged 50 with a supplemental PCV dose at age 65 may offer improved health outcomes but comes with increased costs,” concluded authors of the current study.¹ “Despite uncertainties in duration of protection and indirect effects from vaccination, age-based pneumococcal vaccination starting at age 50 has the potential to enhance disease prevention across a broad portion of the population.”

READ MORE: Pneumococcal Resource Center

REFERENCES

1. Bletnitsky S, Leidner AJ, Kobayashi M, et al. Cost-effectiveness analysis of expanding the adult pneumococcal vaccination recommendations to include adults aged 50 years and older in the United States. Am J Prev Med. May 22, 2026:108412. https://doi.org/10.1016/j.amepre.2026.108412

2. CDC recommends lowering the age for pneumococcal vaccination from 65 to 50 years old. News Release. CDC. October 23, 2024. Accessed June 2, 2026. https://www.cdc.gov/media/releases/2024/s1023-pneumococcal-vaccination.html

3. Nowosielski B, Garofoli GK. FAQ: how a variety of pneumococcal vaccines protect patient populations. Drug Topics. May 12, 2026. Accessed June 2, 2026. https://www.drugtopics.com/view/how-a-variety-of-pneumococcal-vaccines-protect-patient-populations

4. Yi Z, Owusu-Edusei K, Elbasha EH. Economic evaluation of PCV21 in PCV-naïve adults aged 50–64 years in the United States. Vaccine. 2025;59:127264. https://doi.org/10.1016/j.vaccine.2025.127264

5. Stoecker C, Wang Y, Leidner AJ, et al. Cost-effectiveness of age-based and risk-based use of the new 21-valent pneumococcal conjugate vaccine among U.S. adults. Vaccine. 2025;69:127940. https://doi.org/10.1016/j.vaccine.2025.127940

6. Pneumococcal vaccine recommendations. CDC. February 25, 2026. Accessed June 2, 2026. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html