A recent update from the Advisory Committee on Immunization Practices (ACIP), published in the latest MMWR and Morbidity Report, confirms the ACIP parity recommendation for either PCV21 or PCV20 (Prevnar20) for adults aged 50 and older. Importantly, the risk-based recommendation for adults aged 19–49 remains unchanged.
Why the Change?
Expanding these recommendations seeks to improve pneumococcal disease prevention for adults aged 50–64, a group at moderate risk for disease, higher than adults aged 19–49 but lower than those aged 65 and older. The new guidelines also aim to reduce racial health disparities, particularly in Black and American Indian/Alaska Native (AI/AN) populations, who experience disproportionately higher rates of pneumococcal disease.
The updated recommendations now advise PCV vaccination for all adults aged 50 and older who have not yet received the vaccine or whose vaccination history is unknown. For individuals who started their vaccination series with PCV13, PPSV23 (the 23-valent polysaccharide vaccine) is no longer necessary to complete the series. Instead, these individuals should receive either PCV20 or PCV21 to complete their vaccination.
What You Need To Know
MMWR confirms the ACIP parity recommendation for either PCV21 or PCV20 (Prevnar20) for adults aged 50 and older, with PCV21 as the preferred option due to its broader serotype coverage and better cost-effectiveness.
The risk-based pneumococcal vaccination recommendation for adults aged 19–49 remains unchanged, meaning those at higher risk (eg, individuals with chronic conditions) will still follow the previous guidelines.
ACIP now recommends universal pneumococcal vaccination for all adults aged 50 and older, regardless of health status, who have not received the vaccine or whose vaccination history is unclear.
The key change is the parity recommendation for PCV21 or PCV20 for adults aged 50 and older. Both vaccines are recommended as viable options, but PCV21 is preferred due to its broader serotype coverage and cost-effectiveness. In areas where serotype 4 is more prevalent, PCV20 may still be the preferred choice.
Although, the risk-based pneumococcal vaccination guidelines for adults aged 19–49 remain unchanged. This group will continue to follow vaccination recommendations based on individual health risks, particularly for those with chronic conditions that put them at higher risk for pneumococcal disease.
Clinical trials and post-licensure surveillance have confirmed that PCV vaccines, including PCV15, PCV20, and PCV21, are safe and well-tolerated, with no major adverse events reported. Following PCV20 vaccination, a low signal for Guillain-Barré Syndrome (GBS) was observed, particularly in Medicare beneficiaries aged 65 and older, but the incidence remains low.
Economic analyses show that PCV21 is the most cost-effective option for adults aged 50–64, especially in areas with diverse circulating pneumococcal strains. PCV21 provides broader coverage compared to PCV20, though both vaccines are viable options.
The January 2025 update reflects finalized guidance from the October 2024 ACIP meeting and addresses concerns over cost-effectiveness and sereotype coverage. The age-based guidelines are expected to improve vaccination coverage and reduce pneumococcal disease in adults aged 50–64. Simplifying implementation compared to previous risk-based recommendations will make it easier for healthcare providers to offer vaccines in routine clinical settings.
References
1. Kobayashi M, Leidner AJ, Gierke R, et al. Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep 2025;74:1–8. DOI: http://dx.doi.org/10.15585/mmwr.mm7401a1
