Uptake of 20-Valent Pneumococcal Conjugate Vaccine (PCV20) Among United States (US) Adults Following 2022 Update to Recommendations

OBJECTIVES: The US Advisory Committee on Immunization Practices (ACIP) recently updated recommendations for adult pneumococcal vaccination (publication date, 01/27/2022), incorporating new vaccines (e.g., PCV20) and recommending conjugate vaccines for a broader population (i.e., adults aged 19-64 years with certain chronic medical conditions). This study was conducted to measure uptake of the recommendations and disparities in uptake across subgroups of adults.

METHODS: A retrospective observational cohort design and data from the Optum Clinformatics DataMart were employed. The study population comprised all adults aged ≥19 years enrolled in a participating health plan on 01/27/2022 (“index date”) and had ≥1 year of continuous pre-index health plan enrollment. Cumulative uptake of PCV20 from index date to the end of the study period (08/31/2023, or disenrollment date if earlier) was estimated using the Kaplan-Meier method. Analyses were conducted focusing on subgroups of adults for whom pneumococcal vaccination is currently recommended (i.e., persons aged ≥65 years and those with ≥1 chronic medical [“at-risk”] condition or ≥1 immunocompromising [“high-risk”] condition).

RESULTS: Among the 11.2 million adults in the study population, 51% were aged ≥65 years and 38% had at-risk conditions (24%) or high-risk conditions (14%); on an overall basis, mean (median) duration of follow-up was 1.3 (1.6) years. Among adults aged ≥65 years, PCV20 uptake (% [95% CI]) was 10.4% (10.4-10.5) for those aged 65-74 years and 6.4% (6.4-6.4) for those aged ≥75 years. Among adults of all ages, PCV20 uptake was 9.0% (9.0-9.1) for those with at-risk conditions and 8.7% (8.7-8.8) for those with high-risk conditions.

CONCLUSIONS: Fewer than 1 in 8 eligible US adults received PCV20 in the first 19 months of the updated recommendations, with uptake considerably lower among some subgroups at highest risk. Routine evaluation of vaccination status by providers and additional strategies to increase uptake of the current recommendations should be considered.