The epidemiologic evidence underlying recommendations for use of pneumococcal polysaccharide vaccine among American Indian and Alaska Native populations

► The ACIP no longer recommends routine PPSV23 use for all AI/AN persons <65 years. ► We examine the rationale for this change. ► Certain AI/AN populations continue to suffer higher IPD rates than the general U.S. population. ► Much of the excess burden occurs among those with an existing vaccine indication.