Less than 40% of a sample of US adults eligible for the pneumococcal vaccine had received the vaccine by January 2024, a Centers for Disease Control and Prevention (CDC)–led survey shows.
The researchers, who published the findings this week in Vaccine, surveyed 1,553 vaccine-eligible adults aged 19 to 64 years about their knowledge, attitudes, and pneumococcal vaccine status in January 2024. Adults aged 65 years and older and those aged 19 to 64 years with conditions such as diabetes and cancer are eligible for the vaccine.
Updated vaccine recommendations
“Pneumococcal disease contributes to significant morbidity in the United States,” the authors wrote. “Before October 2024, the Advisory Committee on Immunization Practices [ACIP] recommended pneumococcal vaccination for risk-eligible adults aged 19–64 years; however, as of 2023, vaccination coverage remained low (33.1%).”
In October 2024, ACIP recommended expanding the age-based recommendation to those aged 50 years or older, from 65 years and up, to improve vaccine uptake among high-risk adults.
“Some of the factors that prompted the ACIP to make this change included suboptimal pneumococcal vaccination coverage among risk-eligible adults, preventable differences in pneumococcal disease incidence most notable among adults aged 50–64 years, and the relatively large proportion (30–50 %) of risk-eligible adults aged 50–64 years,” the researchers noted.
Less familiarity with vaccine
Among survey respondents, 39.2% said they had received at least one dose of pneumococcal vaccine, 50.6% were unvaccinated, and 10.2% were unsure whether they’d been vaccinated.
Relative to vaccinated respondents, a larger proportion of unvaccinated participants were aged 35 to 49 years (37.1% vs 30.1%) and had a high school education or less (52.2% vs 43.3% with a high-school education or less; 34.9% vs 37.6% with a college degree; and 12.9% vs 19.1% with a master’s or professional degree).
A smaller percentage of unvaccinated participants had a healthcare visit in the previous year (69.2% vs 79.4%) or health insurance (86.8% vs 91.7%). Compared with vaccinated adults, unvaccinated respondents of all age-groups were less familiar with pneumococcal vaccines, perceived that the likelihood of infection and severe disease were lower, and were less amenable to be vaccinated after receiving a recommendation from their clinician.
The findings were statistically significant across all age-groups, except for perceived likelihood of pneumococcal infection in adults aged 50 to 64 years and anticipated disease severity in those aged 35 to 49.
Clinician lack of familiarity may be barrier
Participants with health insurance and those with more years of education were more likely to be vaccinated after receiving a clinician recommendation. The most common reasons for getting vaccinated were, “To protect myself from getting pneumococcal disease” (62.7%) and “My healthcare provider recommended that I get vaccinated” (57.9%). The top reasons for being unvaccinated were, “I did not know I needed to get a pneumococcal vaccine” (31.7%) and “My healthcare provider never recommended I should get a pneumococcal vaccine” (27.9%).
While many healthcare providers recognize the importance of pneumococcal vaccination, their unfamiliarity with the nuances of the risk-based vaccination recommendations may impede their accurate interpretation and implementation.
Clinicians (63.6%) were cited as the most trusted source of information, followed by the CDC (42.5%), regardless of participant vaccination status.
“While many healthcare providers recognize the importance of pneumococcal vaccination, their unfamiliarity with the nuances of the risk-based vaccination recommendations may impede their accurate interpretation and implementation,” the authors wrote. “These challenges could contribute to the observed differences in pneumococcal disease incidence across demographic groups.”
Provider resources available
The team recommended continued efforts to improve clinician and patient education by using existing resources: “To increase vaccination coverage among all adults with indications, the National Vaccine Advisory Committee developed Standards for Adult Immunization Practice, which includes recommendations for all providers to assess immunization needs at each patient encounter; to recommend needed vaccines to patients; and to stay up to date on and educate patients about vaccine recommendations.”
Clinicians can use CDC’s free PneumoRecs VaxAdvisor app for current patient-specific recommendations. “For adults aged 50–64 years, transitioning from a risk-based to an age-based vaccination approach following the updated ACIP recommendation may improve pneumococcal vaccination coverage by removing implementation barriers associated with a risk-based recommendation for providers,” the researchers concluded.