Projected epidemiological impact of lowering the adult pneumococcal vaccination age from 60 to 50 years in Germany

The epidemiological impact of lowering the vaccination age of German adults from 60 to 50 y was evaluated. An age- and serotype-specific dynamic transmission model was used to evaluate the impact of vaccination with either the 23-valent pneumococcal polysaccharide vaccine (PPSV23) or the 20-valent or 21-valent pneumococcal conjugate vaccines (PCV20 and V116, respectively) on pneumococcal disease incidence, including invasive pneumococcal disease (IPD) and inpatient and outpatient non-bacteremic pneumococcal pneumonia, over 10 y. The base case (PPSV23 of ages ≥60 at a 30% vaccination coverage rate [VCR]) was compared against four alternative scenarios with varying pneumococcal conjugate vaccines (PCV20 vs. V116) and starting age of universal vaccination (60 vs. 50) at the same VCR of 30%. Among all adults (ages ≥18) and compared to PPSV23 vaccination at ≥60 and a VCR of 30%, V116 led to 415,452 fewer cases of total pneumococcal disease, while vaccination at ≥50 led to 520,128 fewer cases; PCV20 with those same settings led to 230,950 and 325,694 fewer cases, respectively. When vaccinating ages ≥60 and ≥50 with V116, the projected incidence of IPD in year 10 declined to 22.1 and 20.5 per 100,000, respectively, and when using PCV20 in the same conditions, incidence was 23.0 and 21.8, respectively. In summary, lowering the adult vaccination age enhanced the epidemiological impact of pneumococcal vaccination in Germany, with V116 showing the greatest overall reductions in disease.