Auburn faculty explain CDC’s new pneumococcal vaccine recommendations

This fall, the Centers for Disease Control and Prevention (CDC) significantly lowered the recommended age for the pneumococcal vaccine from 65 to 50. This recommendation was effective immediately, meaning health care providers are already offering vaccines to adults 50 to 64 years old.

Reducing the spread of infectious diseases requires collaboration from experts and clinicians across disciplines. Auburn University’s Salisa Westrick and Spencer Durham, both from the Harrison College of Pharmacy, and Linda Gibson-Young of the College of Nursing are multidisciplinary experts who are working to enhance immunization rates and reduce infectious diseases.

What evidence led the CDC to lower the recommended age for the pneumococcal vaccine from 65 to 50 years?

SW: Based on data presented to the CDC’s Advisory Committee on Immunization Practices (ACIP), the incident rate of invasive pneumococcal disease (IPD) in people 50 to 64 years old was similar to the rate for those 65 and older. Further, the IPD mortality rate in adults 50 to 64 years old has become closer to that of adults 65 and older.

ACIP also considered health equity across different races and ethnicities. For example, the IPD rates in Black adults peak at a younger age compared with non-Black adults. By lowering the age recommendation from 65 to 50, we can improve vaccine coverage for those with known or unknown risk conditions and provide protection earlier in these populations.

Lastly, simplifying the recommendation from risk-based to age-based recommendations may help with the implementation of the recommendations.

Has the safety of this vaccine already been studied in a younger age group?

SW: Yes. Based on the safety data for Prevnar 20, one of the pneumococcal vaccines, between October 2021 and August 2024, there were 2,767 reports submitted to the Vaccine Adverse Event Reporting System in adults 19 and older. Of those, 18 reports were for Guillain-Barré Syndrome, a known but rare complication of most vaccines. That is an occurrence rate of 0.7 case per million doses.

Overall, the vaccine is extremely safe in this age group.

How effective is the pneumococcal vaccine in preventing disease in the 50- to 64-year-old age group compared to those 65 and older?

SD: Efficacy with the pneumococcal vaccines has varied across studies, and different rates are reported with different vaccine products. But in general, the overall efficacy in adults 50 to 64 years old is similar to the efficacy in those 65 and older and is thought to be around 60-70% effective in preventing IPD.

Beyond communicating this change to patients, what challenges may prevent widespread implementation of this recommendation?

SD: Because a number of vaccines are recommended in this same age group, some people may experience vaccine fatigue and may be reluctant to get multiple vaccines. Additionally, since the COVID-19 pandemic, there has been an increase in misinformation related to vaccines, and some people are reluctant to get any vaccines despite their proven safety. By improving the uptake of the vaccine, we can potentially reduce the overall incidence of pneumococcal disease in the community, which ideally would lead to lower morbidity and mortality for patients and less strain on the health care system.

LGY: Some of the challenges of implementing vaccination recommendations include patient misinformation and access issues. We are educating the community on vaccination implementation recommendations with face-to-face visits from pharmacy and nursing students and faculty. Auburn’s Rural Health Initiative has made substantial efforts to address barriers by offering vaccination days dedicated to meeting people where they are. 

Are there any cost-related barriers that might affect vaccine uptake in this age group?

SD: For patients receiving Medicare and Medicaid benefits, ACIP-recommended vaccines are covered at no cost to the patients. Most private health insurance plans also provide these vaccines at no cost. However, uninsured patients may find vaccination cost-prohibitive, although coupons are sometimes available.