Survey Reveals HCP Challenges With Pneumococcal Vaccine Recommendations 

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Findings from this survey were presented at the October 2022 ACIP meeting.

While health care providers understand the value of pneumococcal vaccination, there appear to be knowledge gaps and implementation challenges with the recommendations, according to survey results published in the Centers for Disease Control and Prevention (CDC)’s recent Morbidity and Mortality Weekly Report

The web-based survey was conducted by the Healthcare and Public Perceptions of Immunizations (HaPPI) Survey Collaborative during September 28 to October 10, 2022, before the October 2022 ACIP meeting. The survey assessed vaccine provider behaviors and attitudes regarding pneumococcal vaccine recommendations, knowledge of the recommendations, and attitudes toward including the new pneumococcal 20-valent conjugate vaccine (PCV20) vaccine as an option for patients who had previously received pneumococcal 13-valent conjugate vaccine (PCV13). Among the 829 health care providers (family physicians, general internists, and pharmacists) who consented to participate, 757 completed the survey.  

Results showed that 38% (n=283/751) of respondents disagreed or strongly disagreed with the statement “the current adult pneumococcal vaccine recommendations are easy to follow”. Thirteen percent of participants (n=98) believed the recommendations were confusing and 8% (n=61) felt there were too many choices; 4% (n=28) found it difficult to keep track of the recommended sequence. 

When asked about specific challenges to implementation, 2% (n=14) reported lack of knowledge of patient vaccination history and 0.6% (n=5) noted vaccine supply as issues of concern. Additionally, 25% of family physicians (n=63), 22% of general internists (n=56), and 16% of pharmacists (n=40) reported that vaccine hesitancy was the reason for not recommending PCVs to patients. 

Survey results also showed that approximately 50% (n=372/750) of respondents were not familiar with the 2021 ACIP pneumococcal vaccination recommendations for PCV15 and PCV20. However, two-thirds of participants agreed or strongly agreed with expanding use of PCV20 among high risk adults who previously received PCV13.

Findings from this survey were presented at the October 2022 ACIP meeting in which the ACIP updated its recommendations to allow adults at high risk (ie, immunocompromising condition, a cerebrospinal fluid leak, or a cochlear implant) who have received both PCV13 and pneumococcal 23-valent polysaccharide vaccine (PPSV23) with incomplete vaccination status to have the option to receive a dose of PCV20 instead. Shared clinical decision-making was also recommended when deciding on PCV20 use for those 65 years and older who had completed the recommended vaccine series with both PCV13 and PPSV23.

“The survey findings indicate a need to increase provider awareness and implementation of pneumococcal vaccination recommendations and to provide tools to assist with patient-specific vaccination guidance,” the authors concluded. One such tool is the CDC’s PneumoRecs VaxAdvisor mobile app.


Khan R, Zielinksi L, Gedlinske A, et al. Health care provider knowledge and attitudes regarding adult pneumococcal conjugate vaccine recommendations – United States, September 28-October 10, 2022. Published online September 8, 2023. MMWR.