What are the major changes in the ACIP recommendations for pneumococcal vaccination of adults since January 2022?

In January 2022, CDC published recommendations for two pneumococcal conjugate vaccines (PCV15 and PCV20) as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP stopped recommending PCV13 for adults; however, in rare circumstances if only PCV13 is accessible and the patient would otherwise be unvaccinated, CDC continues to state that PCV13 may be used. When PCV15 is used routinely, it should be used in series with PPSV23 given one year later.

In June 2024, CDC recommended PCV21 (Merck) as an option in all situations where PCV is recommended for adults. As with PCV20, PPSV23 is not recommended following PCV21.

For adults eligible for pneumococcal vaccine as a result of age or a high-risk condition who have no or unknown history of PCV, the same vaccination schedule options apply to all of them: either give one dose of PCV20 or PCV21 alone, or give a dose of PCV15 followed by a dose of PPSV23 one year later (with a minimum interval option of 8 weeks for people with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak). Since January 2022, pneumococcal recommendations are the same for all people age 19 through 64 with immunocompromising and non-immunocompromising underlying medical conditions and other risk factors for pneumococcal disease.

Details of the January 2022 recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104a1-H.pdf. These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/index.html.

Immunize.org has developed standing orders for pneumococcal vaccination of adults that include the use of PPSV23 and all PCV options, including PCV21, at: www.immunize.org/catg.d/p3075.pdf.