13-Valent pneumococcal vaccine no more recommended for elderly: CDC

13-valent pneumococcal conjugate vaccine (PCV13) is no longer recommended for all people aged 65 years and above, according to the Centers for Disease Control and Prevention (CDC). However, they still need to receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Seniors with an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant should still continue to receive PCV13.

Two pneumococcal vaccines are currently licensed for use in adults in the United States: PCV13 (Prevnar 13, Pfizer, Inc.) and a PPSV23 (Pneumovax 23, Merck and Co., Inc.). The new CDC recommendation defies the earlier recommendation of 2014 by the Advisory Committee on Immunization Practices (ACIP) that -- PCV13 is recommended for all seniors in series with PPSV23 for all adults aged ≥65 years.

The new recommendations are published in the journal Morbidity and Mortality Weekly Report (MMWR).

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Streptococcus pneumoniae (pneumococcus) can cause serious illness, including sepsis, meningitis, and pneumonia with bacteremia (invasive) or without bacteremia (noninvasive). Since the early 1980s, PPSV23 has been recommended for persons aged ≥2 years with certain underlying medical conditions, and all adults aged ≥65 years. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine pediatric immunization schedule in 2000 and was replaced by PCV13 in 2010. In 2012, PCV13 was recommended in series with PPSV23 for adults aged ≥19 years with immunocompromising conditions, CSF leaks, or cochlear implants.

Between 2000 and 2014, during the time pneumococcal vaccination was introduced in children, PCV13-type invasive disease among seniors declined ninefold. However, since 2014, when seniors began routinely receiving the vaccine (as recommended by ACIP), there have been no further declines.

ACIP recommends a routine single dose of PPSV23 for adults aged ≥65 years. Shared clinical decision-making is recommended regarding administration of PCV13 to persons aged ≥65 years who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13. If a decision to administer PCV13 is made, PCV13 should be administered first, followed by PPSV23 at least 1 year later.

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The article, "Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices," is published in the journal Morbidity and Mortality Weekly Report.

DOI: http://dx.doi.org/10.15585/mmwr.mm6846a5