One of the quality measures that the health delivery system in the U.S. mandates is the delivery of vaccinations to prevent communicable diseases that are serious and preventable. One vaccine that has attracted a lot of attention due to its prevalence in ads on television, and the concerted effort on prevention measures for seniors, is the pneumococcal vaccine.
Common questions that people ask include:
- Does the vaccine actually prevent pneumonia?
- Should everyone (at a certain age) receive the vaccine?
- What are the risks of getting the vaccine, if any? Do they include not remembering whether you received it and then getting it a second time?
- There’s a newer version of the vaccine. Is it better? Does it have any new side effects?
Pfizer has been involved in an extensive direct-to-consumer advertising campaign about its newer product, a new pneumonia vaccine called Prevnar 13 (PCV13). Readers have likely seen the ads for this vaccine on TV and in various publications. Vaccines are designed against antigens and while Prevnar is actually directed at “less antigens” than the Pneumovax 23 (PPSV23), Pfizer still claims that it will protect against most of the causes of pneumonia, making it the more successful vaccine. Ninety percent of pneumonia is caused by streptococcus.
The vaccine does appear to be very effective based on the current data that the company has shared, but it is also much more expensive than the PPSV23.
PCV13 is approved for the prevention of pneumonia caused by the bacteria streptococcus pneumoniae, which is typically spread from person to person by cough. There are many strains of this bacterium, more than 90 serotypes, but ten of the most common types are responsible for 62 percent of all cases of pneumonia. The PCV13 protects individuals from 13 different strains.
Who should receive the pneumonia vaccine?
The Centers for Disease Control and Prevention (CDC) recommends vaccination for all babies and children younger than 2 years old and all adults 65 years or older.
Although pneumococcal bacteria can spread from person to person by direct contact or through coughing, it can also be present in the body’s secretions from the nose and throat without causing disease to the person. It is estimated that pneumococcus can be isolated from the nasopharynx of five to 70 percent of healthy adults.
There are two types of pneumonia vaccine
The pneumonia polysaccharide vaccine is the “older standard” vaccine and is designed to protect against 23 strains. Its current familiar name is Pneumovax23 or just Pneumovax. This vaccine, unlike the PCV13, is recommended for people between 2 and 64 years of age with certain conditions, as well as to individuals between 19 and 64 years of age who are cigarette smokers.
The other type of vaccine is the new pneumococcal conjugate vaccine (PCV13) described above.
Under what other special circumstances should someone get the vaccine?
Individuals who currently have chronic illnesses such as HIV, sickle cell disease, diabetes, and renal disease, individuals with cerebrospinal fluid leak (CSF leak), or individuals who have had a splenectomy should all receive the pneumococcal vaccine.
Why get either vaccine?
The goal of the vaccination program is to prevent two major clinical situations from arising, either of which can have severe consequences once you have pneumonia. One is bacteremia, which is the spread of the bacteria from the lungs through the rest of the blood. The other situation is meningitis, which is an infection to the cerebrospinal fluid that surrounds the brain and the spinal cord. This, too, can become a life-threatening condition.
The major purpose of being vaccinated with one of these two vaccine options is to prevent these serious secondary conditions. Pneumococci cause 50 percent of all cases of bacterial meningitis in the United States. There are 3,000 to 6,000 cases of pneumococcal meningitis every year.
What is the specific difference between the two vaccines?
The major difference between the vaccines is that the conjugate form, PCV13, has a higher immunogenicity. This means that it will stimulate a higher immune reaction. One injection of PCV13 may provide lifetime immunity. The Pneumovax must be given in two doses total, five years apart.
Because hospitals are encouraged to urge all seniors being admitted to receive a pneumonia vaccine, individuals are often times unsure whether or when they may have already received it.
Are there any risks associated with receiving vaccine doses in too close proximity?
In the case of PPSV23, side effects of re-vaccination at intervals of less than 5 years are usually local reactions at the site of injection (sore arm) and possibly a low-grade temperature. Researchers have yet to determine whether there are any other effects of re-vaccination after a second dose of vaccine. At this time, having a third re-vaccination with PPSV23 is not recommended. Some seniors may receive a Prevnar13 first and then a re-vaccination with PPSV23 a year later when the response to the original vaccination is deemed “low-antibody response” by blood test.
It’s important to recognize that these vaccines are given to prevent serious secondary infections that have significant mortality rates.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.