You may have seen recent advertising for the pneumococcal vaccine on TV or in magazines. Pneumococcal vaccines have been around for a number of years but it is being promoted now because the recommendations for the vaccine have recently changed.
The pneumococcus is a type of bacteria. If you are a microbiologist you know it as a gram positive diplococcus. This is an important bacterium because it is common and can cause invasive severe bacterial infections. It is best known for causing pneumonia though it is also a frequent cause of ear infections, sinus infections, and meningitis. It tends to make people severely ill when it invades tissues and gets into the blood stream. Pneumococcal infections can come on rapidly and be fatal even though there are effective antibiotics against the pneumococcus. Pneumonia can be caused by infectious agents other than pneumococcus. The vaccine only protects against pneumococcus.
A vaccine has been developed against the pneumococcus. The bacteria have a protective capsule that has different chemicals on its surface that has allowed scientists to identify different strains. The first vaccines included 23 of the subtypes that were felt to cause about 90% of the serious infections. This vaccine, referred to as PPSV23, was only useful in adults. Then in year 2000 a vaccine for children was developed by linking some of the pneumococcal antigens to a protein to make it more effective at stimulating antibody production. This was known as a conjugate vaccine and was effective for infants. The current conjugate vaccine has 13 types and is known as PCV13 and is advised for all infants.
In 2014 the advisory board changed its recommendations for adults regarding the use of PCV13. PPSV23 is still used but the current guidelines advise the use of both vaccines for certain groups. It is felt that the PCV13 may prepare the immune system to respond to pneumococcal antigens, so that when possible, it should be given first.
So, if I haven’t confused you too much already, I will try to outline the current recommendations. It is advised that everyone over age 65 receive pneumococcal vaccine. If no vaccine has been given previously, the PCV13 is given followed by PPSV23 after 6-12 months. If both vaccines are given after age 65 there is no need for revaccination. For those over 65 who already had the PPSV23 it is advised to give the PCV13 at least one year after the PPSV23 was given.
Now it gets trickier. If someone received PPSV23 prior to age 65, then PCV13 is advised at least one year from the PPSV23 vaccination. Then that person would get one PPSV23 vaccine booster after age 65 years of age and at least five years from the first PPSV23 shot.
Adults less than 65 years old would be candidates for the vaccine if they are at high risk for pneumococcal infections. Those considered at risk would be diabetics, people with heart or lung disease, people with cirrhosis, smokers, alcoholics, or people with a cochlear ear implant. Also candidates include people with their spleen removed or an immune deficiency due to AIDS, cancer, or those taking medications that suppress the immune system. These people would receive the PCV13 followed by PPSV23 at least eight weeks later. An additional one time PPSV23 booster would be advised five years later. Then after age 65 one last PPSV23 booster five years from the last PPSV23 would be given.
Vaccinations can preserve health by preventing infectious disease. Pneumococcal vaccination recommendations have recently changed and are outlined above. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
