Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations

J Am Board Fam Med. 2018 Jan-Feb;31(1):94-104. doi: 10.3122/jabfm.2018.01.170216.


Introduction: In 2012, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for at-risk adults ≥19; in 2014, it expanded this recommendation to adults ≥65. Primary care physicians' practice, knowledge, attitudes, and beliefs regarding these recommendations are unknown.

Methods: Primary care physicians throughout the U.S. were surveyed by E-mail and post from December 2015 to January 2016.

Results: Response rate was 66% (617 of 935). Over 95% of respondents reported routinely assessing adults' vaccination status and recommending both vaccines. A majority found the current recommendations to be clear (50% "very clear," 38% "somewhat clear"). Twenty percent found the upfront cost of purchasing PCV13, lack of insurance coverage, inadequate reimbursement, and difficulty determining vaccination history to be "major barriers" to giving these vaccines. Knowledge of recommendations varied, with 83% identifying the PCV13 recommendation for adults ≥65 and only 21% identifying the recommended interval between PCV13 and PPSV23 in an individual <65 at increased risk.

Conclusions: Almost all surveyed physicians reported recommending both pneumococcal vaccines, but a disconnect seems to exist between perceived clarity and knowledge of the recommendations. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers.

Keywords: Family Physicians; Insurance Coverage; Pneumococcal Vaccines; Primary Care Physicians; Vaccination.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Clinical Competence / statistics & numerical data*
  • Female
  • Health Plan Implementation / statistics & numerical data
  • Health Plan Implementation / trends
  • Humans
  • Immunization Schedule
  • Male
  • Middle Aged
  • Physicians, Primary Care / statistics & numerical data*
  • Physicians, Primary Care / trends
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines / administration & dosage*
  • Practice Guidelines as Topic
  • Surveys and Questionnaires / statistics & numerical data
  • United States
  • Vaccination / standards*
  • Vaccination / statistics & numerical data
  • Vaccination / trends
  • Vaccines, Conjugate / administration & dosage


  • 23-valent pneumococcal capsular polysaccharide vaccine
  • Pneumococcal Vaccines
  • Vaccines, Conjugate