Uptake of Pneumococcal Vaccines Among U.S. Adults After 2022 Update to Recommendations

Abstract

Introduction

Updated recommendations for adult pneumococcal vaccination in the U.S. (publication date: January 27, 2022) incorporated 2 new vaccines (15- and 20-valent pneumococcal conjugate vaccines), removed 13-valent pneumococcal conjugate vaccine, and called for pneumococcal conjugate vaccine use among immunocompetent adults aged 19–64 years with certain medical conditions. This study assessed uptake of recommendations and disparities in uptake across subgroups of adults.

Methods

A retrospective cohort design and data from Optum’s deidentified Clinformatics Data Mart Database were employed. Study population comprised all adults aged ≥65 years and adults aged 19–64 years with ≥1 chronic (at-risk) or immunocompromising (high-risk) condition. Vaccine uptake (including 23-valent pneumococcal polysaccharide vaccine) was estimated using the Kaplan–Meier method.

Results

During 21-month follow-up period, 13.2% of adults (n=6.8 million) received pneumococcal vaccine, mostly 20-valent pneumococcal conjugate vaccine (9.6%). By age/risk conditions, 20-valent pneumococcal conjugate vaccine uptake was highest among adults aged 65–66 years (23.8%) and at-risk/high-risk adults aged 60–64 years (12.1%) and lowest among at-risk/high-risk adults aged 19–49 years (4.7%). By immunization history, 20-valent pneumococcal conjugate vaccine uptake was highest among adults with a history of 23-valent pneumococcal polysaccharide vaccine uptake only (15.1%) or 13-valent pneumococcal conjugate vaccine uptake only (10.6%) and lowest among those without prior pneumococcal vaccination (8.7%) or with a history of 13-valent pneumococcal conjugate vaccine + 23-valent pneumococcal polysaccharide vaccine uptake (7.9%).

Conclusions

Fewer than ∼1 in 7 U.S. adults received 20-valent pneumococcal conjugate vaccine in the first 21 months after the updated recommendations. Uptake was lower among at-risk/high-risk adults aged <60 years, adults aged ≥75 years, and adults without prior pneumococcal vaccination. Routine evaluation of vaccination status by providers and additional strategies to increase uptake of recommend vaccines are warranted.