BQ Journal Vol 43 - Q2 2021 - 23

Morbidity and Mortality Weekly Report
TABLE. Change in weekly percentage* of Medicare beneficiaries aged
≥65 years who received routinely recommended adult vaccines,
overall and by race/ethnicity† - United States, January-July 2020
% Change in weekly vaccination rate¶
Vaccine§ and
race/ethnicity
PCV13
Total
White
Black
Hispanic/Latino
Asian
Other
PPSV23
Total
Hispanic/Latino
Asian
Other
Td/Tdap
Total
Hispanic/Latino
Asian
Other
RZV
Total
Hispanic/Latino
Asian
Other
Prepandemic
average
Jan 5-Feb 29
−20
−20
−20
−20
−10
−17
12
White12
Black
9
10
22
13
5
1
−3
11
10
47
White46
Black
57
65
58
56
Pandemic
nadir**
−88
−88
−87
−89
−92
−89
−80
−81
−70
−78
−85
−83
−70
White5 −68
Black
−76
−80
−86
−76
−89
−89
−86
−88
−91
−89
Most recently
assessed
pandemic week
July 12-18
−43
−42
−44
−62
−57
−42
8
10
−2
−22
−9
3
−24
−23
−30
−44
−38
−34
−44
−44
−11
−40
−53
−44
Source: Medicare enrollment and claims data from the Centers for Medicare &
Medicaid Services Chronic Conditions Warehouse. https://www2.ccwdata.org/
web/guest/home
Abbreviations: ACIP = Advisory Committee on Immunization Practices; PCV13 =
13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal
polysaccharide vaccine; RZV = recombinant zoster vaccine; Td/Tdap = tetanusdiphtheria
or tetanus-diphtheria-acellular pertussis vaccine.
* Calculated as the percentage of the study sample of Medicare enrollees who
received ≥1 dose of the vaccine during that week. Percentage change in
vaccination rate in a week was calculated as the ratio of the vaccination rate
in that week in 2020 to the rate in the corresponding week in 2019, minus 1.
† Black, White, Asian, and Other racial/ethnic groups were non-Hispanic;
Hispanics could be of any race.
§ Weeks in 2020 were compared with the equivalent weeks in 2019: January 5-
February 29, 2020 versus January 6-March 2, 2019 for prepandemic average;
April 5-11 or April 12-18, 2020 versus April 7-13 or April 14-20, 2019 for nadir;
July 12-18, 2020 versus July 14-20, 2019 for the last examined week.
¶ ACIP voted to stop recommending routine PCV13 use among adults aged
≥65 years in June 2019. In October 2017, RZV was approved by the Food and
Drug Administration and recommended preferentially over Zoster Vaccine
Live by ACIP for use in immunocompetent adults aged ≥50 years.
** Nadirs were observed during April 5-11 and April 12-18, 2020, depending
on vaccine and race/ethnicity group.
Among Medicare enrollees in the study sample, an average
(across all vaccines studied) of 85% were White, 7% were
Black, 4% were Other racial and ethnic groups, and 2% each
were Asian or Hispanic. Patterns of decline and recovery in
vaccination among each racial/ethnic group were similar to
the overall findings, but certain disparities in magnitude were
observed (Table). By the most recently assessed week, the rate
of PPSV23 receipt among White adults was 10% higher than
that during the corresponding week in 2019, and the declines
in PCV 13 and Td/Tdap vaccination (42% and 23%, respectively)
were smallest among White adults. By comparison,
the change in vaccination rates in the most recent week of the
study period compared with the corresponding week in 2019
ranged from -57% (PCV13) to -9% (PPSV23) for Asian
adults, -44% (PCV13) to -2% (PPSV23) for Black adults,
-62% (PCV13) to -22% (PPSV23) for Hispanic adults, and
-44% (RZV) to 3% (PPSV23) for Other race adults. The
smallest decline in RZV vaccination rate (11%) during the
most recent week was among Black adults.
Discussion
Before the March 13, 2020, COVID-19 national emergency
declaration, the weekly rate of receipt of PPSV23, Td/Tdap,
and RZV** among Medicare beneficiaries aged ≥65 years in
2020 was consistently higher than that in the corresponding
2019 week. Because the Advisory Committee on Immunization
Practices voted in June 2019 to stop recommending PCV13
for adults aged ≥65 years,†† vaccination with PCV13 among
this population declined in 2020 compared with that in 2019.
Since the declaration, rates of adult vaccination with these three
vaccines and PCV13 were substantially lower than were those
during the corresponding period in 2019, with steady recovery
after mid-April 2020. These findings are consistent with previous
reports of declines in routine pediatric vaccine ordering and
** The prepandemic weekly RZV vaccination rates in 2020 were notably higher
than those in the equivalent week of 2019, likely because RZV was recently
approved and recommended: In October 2017, RZV was approved by the
Food and Drug Administration and recommended preferentially over Zoster
Vaccine Live by ACIP for use in immunocompetent adults aged ≥50 years.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.
htm?s_cid=mm6703a5_w
†† On June 26, 2019, ACIP voted to stop recommending routine PCV13 use
among adults aged ≥65 years. Instead, ACIP recommended administration
of PCV13 based on shared clinical decision-making for adults aged ≥65 years
who do not have an immunocompromising condition, cerebrospinal fluid
leak, or cochlear implant, and who have not previously received PCV13.
https://www.cdc.gov/mmwr/volumes/68/wr/mm6846a5.
htm?s_cid=mm6846a5_w
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / February 19, 2021 / Vol. 70 / No. 7
247
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A Henry Schein Publication
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BQ Journal Vol 43 - Q2 2021

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