National Center for Immunization & Respiratory Diseases

Pneumococcal Vaccines

Katherine A. Poehling, MD, MPH

Pneumococcal Vaccines Work Group Chair

Advisory Committee on Immunization Practices

October 20, 2021
Pneumococcal Vaccines Work Group

• ACIP Members • Liaison Representatives and Consultants

- Katherine Poehling (Chair)

- Keipp Talbot

- Sarah Long 

- Lynn Fisher (AAFP)

- Mark Sawyer (AAP/COID)

- Jason Goldman (ACP)

- David Nace (AGS/AMDA)

- Emily Messerli (AIM)

- Elissa Abrams (NACI)

- Carol Baker (IDSA)

- William Schaffner (NFID)

- Virginia Caine (NMA)

- Monica Farley (VAMC/Emory)

- Keith Klugman (BMGF)

- Arthur Reingold (UC Berkley)

- Lorry Rubin (CCMC)

- Cynthia Whitney (Emory)

- Richard Zimmerman (U. of Pittsburgh) 

• Ex Officio Members

- Jeffrey Kelman (CMS)

- Lucia Lee (FDA)

- Tina Mongeau (FDA)

- Uzo Chukwuma (IHS)

- Mamodikoe Makhene (NIH)

• CDC Lead

- Miwako Kobayashi (NCIRD)
Pneumococcal Vaccines Work Group

• CDC Contributors

- Tamara Pilishvili (Respiratory Diseases Branch)

- Ryan Gierke (Respiratory Diseases Branch)

- Jennifer Farrar (Respiratory Diseases Branch)

- Penina Haber (Immunization Safety Office)

- Pedro Moro (Immunization Safety Office)

- Sarah Schillie (Immunization Services Division)

- Marc Fischer (Arctic Investigations Program)

- Jessica MacNeil (ACIP Secretariat) 

• GRADE/EtR consultants

- Doug Campos-Outcalt

- Rebecca Morgan
Policy Questions Presented at the September ACIP Meeting 

PCV15 Age-based:

 Should PCV15 be routinely recommended to US adults ≥65 years in series with PPSV23?

PCV15 Risk-based:

 Should PCV15 in series with PPSV23 be recommended for U.S. adults aged 19–64 years with chronic medical 

conditions* or immunocompromising conditions**?

If age-based PCV20 recommendation at age ≥50 years:

 Should PCV20 be routinely recommended to US adults aged ≥50 years? 

 Should PCV20 be recommended for U.S. adults aged 19–49 years with chronic medical conditions* or 

immunocompromising conditions**?

If age-based PCV20 recommendation at age ≥65 years:

 Should PCV20 be routinely recommended to US adults aged ≥65 years? 

 Should PCV20 be recommended for U.S. adults aged 19–64 years with chronic medical conditions* or 

immunocompromising conditions**? 

*Alcoholism, chronic heart/liver/lung disease, diabetes, cigarette smoking

**Chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus infection, Hodgkin disease, leukemia, 

lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies, CSF leak, or cochlear implant
Policy Questions Presented at the September ACIP Meeting 

PCV15 Age-based:

 Should PCV15 be routinely recommended to US adults ≥65 years in series with PPSV23?

PCV15 Risk-based:

 Should PCV15 in series with PPSV23 be recommended for U.S. adults aged 19–64 years with chronic medical 

conditions* or immunocompromising conditions**?

If age-based PCV20 recommendation at age ≥50 years:

 Should PCV20 be routinely recommended to US adults aged ≥50 years? 

 Should PCV20 be recommended for U.S. adults aged 19–49 years with chronic medical conditions* or 

immunocompromising conditions**?

If age-based PCV20 recommendation at age ≥65 years:

 Should PCV20 be routinely recommended to US adults aged ≥65 years? 

 Should PCV20 be recommended for U.S. adults aged 19–64 years with chronic medical conditions* or 

immunocompromising conditions**? 

*Alcoholism, chronic heart/liver/lung disease, diabetes, cigarette smoking

**Chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus infection, Hodgkin disease, leukemia, 

lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies, CSF leak, or cochlear implant

Confusing to have different age-based recommendations by vaccine. 

Request to simplify the policy options for consideration for a vote.
Guiding Principles Proposed by the Work Group

• Decisions on policy options should be supported by best-available evidence

• Simplifying existing pneumococcal vaccine recommendations could help 

improve vaccine coverage among adults

• Disparities in pneumococcal disease burden and vaccine coverage should 

be reduced 

• Timely recommendations for each new vaccine should be made after FDA 

licensure
Rationale for Harmonizing at Age ≥65 years

 Due to potential waning of immunity, vaccination later in life may be 

favorable when risk of disease may be higher

 Consistently cost-saving (lower cost and better health outcome compared 

to current recommendations) in cost-effectiveness analyses

 Proposed risk-based and age-based options still provide an opportunity for 

higher PCV coverage, which may prevent more disease compared with 

current recommendations and may address some health equity concerns
Updated Policy Questions for Consideration

 Should PCV20 alone OR PCV15 in series with PPSV23 be routinely 

recommended to US adults aged ≥65 years? 

 Should PCV20 alone OR PCV15 in series with PPSV23 be 

recommended for U.S. adults aged 19–64 years with certain underlying 

medical conditions or other risk factors*?

*alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus, chronic renal failure, nephrotic syndrome, 

immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, 

leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease or other 

hemoglobinopathies, CSF leak, or cochlear implant.
One risk-based and one age-based recommendation are being considered. 

19–64 years ≥65 years

None of the conditions 

listed below No recommendation

Age-Based Recommendation

Chronic medical conditions† 

(CMC)

Cochlear implant, CSF leak Risk-Based Recommendation

Immunocompromising 

conditions*

†Examples include alcoholism, chronic heart/liver/lung disease, diabetes, cigarette smoking

*Chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human 

immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, 

sickle cell disease or other hemoglobinopathies

https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
Today’s Pneumococcal Vaccines Session Outline

Introduction Dr. Katherine Poehling 

(ACIP, WG Chair)

Considerations for age-based and risk-based use of 

PCV15/PCV20 among adults and proposed policy options

Dr. Miwako Kobayashi 

(CDC/NCIRD)

Discussion Dr. Miwako Kobayashi 

(CDC/NCIRD)