Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients

Pneumococcal Vaccine V116 Reduces Disease Burden, Cost-Effective In Older Adults

V116, a 21-valent pneumococcal conjugate vaccine (PCV21), may confer substantial protection against pneumococcal disease among older adults and be more cost-effective than both 20-valent PCV (PCV20) alone and 15-valent PCV (PCV15) combined with the 23-valent pneumococcal polysaccharide vaccine (PPSV23). These findings were published in Infectious Diseases and Therapy.

After the first PCVs were introduced in 2000, there was a reduction in pneumococcal disease among children. Designed specifically for adults, V116 contains 8 unique serotypes not found in any previously licensed pneumococcal vaccine.

To estimate the cost-effectiveness of V116 administration among older adults in the United States, researchers conducted a static multicohort analysis using a state-transition Markov model. The analysis comprised PCV-naive adults aged 65 to 99 years who were stratified by pneumococcal disease risk. Patient data were captured after administration of either V116, PCV20, or PCV15 plus PPSV23 and used to model outcomes of invasive pneumococcal disease (IPD), inpatient and outpatient nonbacteremic pneumococcal pneumonia (NBPP), post-meningitis sequalae, and mortality due to IPD or NBPP. The researchers calculated annual disease incidences via surveillance data collected between 2017 and 2019. Other outcomes of interest were incremental cost-effectiveness ratios (ICERs) based on 2023 US dollars and discounted quality-adjusted life years (QALYs).

Among patients (N=57,705,864) eligible for the study, 19,375,405 (34.02%) had no documented history of pneumococcal vaccination. Of patients in the vaccine-naive cohort, the estimated rate of vaccination was 55.20%.

"

The use of PCV21 by PCV-naïve adults aged ≥65 would markedly reduce the burden of adult pneumococcal disease, making substantial contributions to public health while saving costs in most situations.

Compared with the administration of PCV20 alone or PCV15 plus PPSV23, V116 was associated with the prevention of 27,766 and 32,387 additional clinical or mortality outcomes overall, respectively. In regard to specific outcomes, V116 resulted in the prevention of 5204 and 4739 additional IPD episodes, 63 and 57 additional post-meningitis sequalae episodes, 8226 and 10,183 additional NBPP episodes, 751 and 683 additional IPD-related mortality episodes, and 351 and 434 additional NBPP-related mortality episodes.

Further analysis of averted clinical and mortality outcomes showed that V116 was associated with 4075 saved QALYs and a $239 million reduction in lifetime medical costs relative to PCV20 and 4177 saved QALYs and a $1.8 billion reduction in lifetime medical costs relative to PCV15 plus PPSV23.

In regard to estimated lifetime incremental clinical and economic impact, V116 was more effective than PCV20 for discounted QALYs (range, 316-5774) and cost-savings (range, -$478,621,661 to -$15,984,988) across most modeled scenarios. Similar findings were observed when V116 was compared with PCV15 plus PPSV23, both in terms of discounted QALYs (range, 294-6749) and cost-savings (range, -$2,187,867,035 to -$121,967,176). However, from the health-sector perspective, PCV20 was more cost-effective than V116 (ICER, $3873/QALY gained).

In both deterministic and probabilistic sensitivity analyses, V116 was favored over PCV20 for cost-effectiveness.

Limitations of this study include the lack of reliable data given the complexity of pneumococcal disease, as well as the use of simplified assumptions in the Markov model.

According to the researchers, "The use of PCV21 by PCV-naïve adults aged ≥65 would markedly reduce the burden of adult pneumococcal disease, making substantial contributions to public health while saving costs in most situations."

Disclosure: This research was supported by Merck Sharp & Dohme LLC, and multiple study authors declared affiliations with industry. Please see the original reference for a full list of disclosures

This article originally appeared on Infectious Disease Advisor

CDC Widens Pneumococcal Vaccine Recommendation To All Over 50

The Centers for Disease Control and Prevention (CDC) now recommends that American adults over the age of 50 receive the pneumococcal conjugate vaccine, or PCV.

The report with the updated recommendation was published on Thursday. Previously, the recommendation for the vaccine was only for adults who were aged 65 and older and people between the ages 19 and 64 who had risks for pneumococcal disease. A PCV protects against pneumococcal bacteria, which can cause pneumonia, meningitis and bloodstream infections.

On Oct. 23, 2024, the Advisory Committee on Immunization Practices (ACIP), which advises the CDC on vaccines, recommended a single dose of PCV for all adults aged 50 and older. The CDC adopted the recommendation, noting that the expanded age recommendation should enhance disease prevention in adults between the ages of 50 and 64, as they face higher rates of infection.

The risk recommendations for those between 19 and 49 years old will stay in place under the new recommendation adoption.

"The recommendation was supported by several factors, including the potential to improve vaccination coverage and reduce pneumococcal disease incidence and mortality in adults aged 50 to 64 years, particularly among demographic groups experiencing higher disease rates," the CDC wrote in its statement.

In 2022, adults who were between 50 and 64 had higher incident rates of infection compared to all other age groups except those who were 65 and up, the CDC noted.

The Streptococcus pneumoniae bacteria causes pneumococcal disease. There are different types of PCV vaccines that the CDC recommends based on a person's age and medical conditions. Older adults who have already had a PCV should talk to their doctor about which PCV to receive. 

Pneumococcal pneumonia affects about 12% to 13% of all people who are hospitalized for pneumonia. The infection leads to about 225,000 adult hospitalizations in the United States each year, the CDC reported.

Does Medicare Cover Pneumonia Shots?

Part D covers most preventive vaccinations, while Part B covers a few specific vaccines, like the pneumonia vaccine. Medicare Advantage plans, sometimes called Part C, also cover the pneumonia vaccine.

Pneumococcal vaccines can prevent common bacterial infections from Streptococcus pneumoniae. There are two types of pneumonia vaccines available to prevent specific strains of this bacteria.

If you receive PCV15, it should be followed by a dose of pneumococcal polysaccharide vaccine (PPSV23).

Part B is medical insurance. It covers preventive healthcare services such as doctor visits, screening and diagnostic tests, and some vaccinations, such as the pneumonia vaccine.

In 2025, most people will pay a monthly premium of $185.00. Your premium may be higher depending on your income.

After you pay a $257 deductible, you'll generally pay 20% of all Medicare-approved costs for covered services. However, there are no out-of-pocket costs for vaccines covered by Part B.

That means you'll pay $0 for the pneumonia vaccine if you go to a healthcare professional who accepts Medicare assignment.

Providers who accept assignment agree to Medicare-approved rates, which are usually lower than standard prices. You can use this tool to find a Medicare-approved provider near you.

Part C plans must cover the same basic services as Original Medicare (parts A and B), including certain vaccinations.

That means the pneumonia vaccine is covered at no out-of-pocket cost to you, aside from your plan's monthly premium.

Each Part C plan sets its own cost and coverage amounts. Your premiums, deductibles, copayments, and coinsurance amounts depend on your chosen plan.

Staying in network, which means getting care from a list of approved healthcare professionals and facilities, usually costs less than going out of network.

When it comes to no-cost services like the pneumonia vaccine, you'll likely need to stay in network to avoid being charged the full cost.

---