Pneumococcal Vaccine Rates Low Despite Updated Recommendations

In 2022, the Advisory Committee on Immunization Practices (ACIP) published updated pneumococcal vaccine recommendations.¹ The committee recommended adults aged 65 years and older who have not received a pneumococcal conjugate vaccine (PCV) or those whose history is unknown receive a single dose of either the 20-valent PCV (PCV20) or 15-valent PCV (PCV15) vaccines. Additionally, when PCV15 is used, a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) should follow.

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However, 21 months after the updated recommendations, fewer than 1 in 7 US adults had received a dose of the PCV20 vaccine and uptake remained low among at-risk or high-risk adults and those without prior vaccination. The data, published in the journal AJPM Focus, highlight the importance of implementing strategies to improve vaccine uptake.²

“Observed low levels of pneumococcal vaccine uptake among eligible US adults persist despite major US public health goals focusing on increasing their use,” the authors wrote. “Increasing pneumococcal vaccine uptake is especially important in light of the recent COVID-19 pandemic that disrupted routine immunization services and highlighted the vulnerability of adults to respiratory infections.”

A team of investigators from Avalere Health and Pfizer conducted a study to assess uptake of pneumococcal vaccine recommendations and disparities in uptake across subgroups of adult patients. The retrospective cohort study gathered data from the Optum de-identified Clinformatics Data Mart Database from January 2015 through October 2023. The study also included data from adults aged 65 years and older who were enrolled in the Medicare Advantage program.

The study cohort included 6.8 million adult patients who were enrolled in a health plan as of January 2022 that contributed data to the Optum database. Approximately 86% were 65 years of age or older, 56% were female, 38% were considered low-risk, 39% were at-risk and 22% were high-risk. Of those, 38% had evidence of pneumococcal vaccination prior to January 2022.

The study found that the uptake of pneumococcal vaccines 21 months after the updated recommendations was 13.2%, with the highest during the first 6 months being the PPSV23 vaccine. By the end of the study period, use of PCV20 was highest at 9.6%, followed by PPSV23 at 3%, PCV13 at 0.8% and PCV15 at 0.2%. Uptake of the PCV20 vaccine was highest among adults aged 65 to 66 years and lowest among at-risk and high-risk adults between the ages of 19 to 49 years.

“While pneumococcal disease decreased during the [COVID-19] pandemic, the incidence has since resurged, and with it the potential for vaccination to improve health outcomes as well as reduce the economic burden on the healthcare system,” the authors concluded. “Accordingly, new and/or better uptake strategies involving educational campaigns, improving vaccine access and affordability, strengthening the provider recommendation, and integrating vaccination with other preventive services are needed.”

READ MORE: Pneumococcal Resource Center

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References

1. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109–117. DOI: http://dx.doi.org/10.15585/mmwr.mm7104a1.

2. Averin A, Vietri J, Mohs AA, et al. Uptake of Pneumococcal Vaccines Among United States Adults Following 2022 Update to Recommendations. AJPM Focus. 2025,100384, ISSN 2773-0654. https://doi.org/10.1016/j.focus.2025.100384.