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The CDC's Advisory Committee on Immunization Practices (ACIP) on Wednesday endorsed additional doses of COVID vaccine for high-risk groups and recommended lowering the age for adult pneumococcal vaccination from 65 to 50 years.

In an update to recommendations from June, in three unanimous votes, ACIP recommended a second dose of the 2024-2025 COVID vaccine for adults ages 65 and older, as well as people ages 6 months to 64 years who are moderately or severely immunocompromised, and additional (three or more) doses for people ages 6 months and older who are moderately or severely immunocompromised under shared clinical decision making.

The advisors also voted 14-1 to recommend a pneumococcal conjugate vaccine (PCV) for all PCV-naive adults ages 50 and older.

Shortly after the ACIP meeting, CDC Director Mandy Cohen, MD, MPH, endorsed the new and recommendations.

In June, CDC advisors recommended that people who are moderately or severely immunocompromised receive additional doses of the 2024-2025 COVID vaccine, though they made no recommendation for additional doses for older adults at that time.

Prior to the vote on Wednesday, Jamie Loehr, MD, of Cayuga Family Medicine in Ithaca, New York, highlighted the incidence rate of COVID hospitalizations among older adults, specifically those ages 75 and older, for the period of Oct. 1, 2023 to Sept. 28, 2024.

"When you look at 1,410 hospitalizations, you think that's a number, but when I did the conversion, that's one in 70 adults," Loehr said. "And that is just stunning that so many people over 75 are going to be admitted to the hospital with COVID. We don't have that with diabetics. We don't have that, maybe, with heart disease, but this is just a stunning number, which I think should be more promulgated."

Data presented by a COVID vaccines work group showed that during the 2023-2024 season, vaccine effectiveness against hospitalization for immunocompromised individuals waned to null by roughly 4 to 6 months after receipt. Vaccine effectiveness against emergency department and urgent care visits, as well as hospitalizations, for adults ages 65 and older also waned to null during that same time frame. However, vaccine effectiveness against critical illness for older adults remained above 40% at 5 months.

Regarding the updated pneumococcal vaccine recommendation, a work group had previously considered other options that included maintaining the status quo (age-based recommendations for those ages 65 and older and risk-based recommendations for younger adults), or lowering age-based recommendations to 50 and older for the new 21-valent PCV (Capvaxive) only.

This vaccine recently received FDA approval for the prevention of invasive pneumococcal disease and pneumococcal pneumonia in adults. Serotypes included in the vaccine cause about 84% of cases of invasive pneumococcal disease in adults 50 and older, according to CDC data. Meanwhile, the 20-valent PCV covers the serotypes responsible for 52% of cases in this age group.

Loehr, who served as chair of the pneumococcal vaccine work group, was the one "no" vote of the day, citing his preference for the 21-valent PCV. It's a "better vaccine," he said, as it "covers many, many more serotypes for adults."

Prior to Wednesday's vote, the majority of a pneumococcal vaccine work group supported the voted-upon recommendation after considering certain factors, including that it is easier to implement a uniform recommendation across all pneumococcal conjugate vaccines, that there are higher pneumococcal disease rates in Black/African-American adults with an earlier peak, and that 33% to 54% of adults ages 50 to 64 already have an indication for risk-based pneumococcal vaccination, among others.

Future considerations should include indirect effects from new pediatric pneumococcal vaccines (vaccination is also recommended in kids under 5 years), duration of protection from adult vaccination, and impacts of new higher-valency vaccines for adults, the work group noted.

ACIP also unanimously voted to include high-dose and adjuvanted inactivated influenza vaccines as options for solid organ transplant recipients who are receiving immunosuppressive medications under the Vaccines for Children program, which makes coverage free for uninsured or underinsured children.

As always, all ACIP recommendations are not considered final until they are published in the Morbidity and Mortality Weekly Report.

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