Pneumonia Vaccines – Now there are 2! 

The bad news  – Pneumococcal pneumonia, nicknamed “the Old man’s friend” is a killer.  Pneumococcal pneumonia is the most common form of pneumococcal disease in afflicting an estimated 900,000 Americans each year.  Approximately 5-7% of its victims die with most of the deaths occuring in people over 65.

The good news – there are vaccines.  The original pneumonia vaccine (PPSV23)   released in 1983  protects against 23 different strains of the bacteria.   But alas there were still infections and deaths from other bacterial strains. In 2010, the FDA approved another vaccine (PCV13) to cover those nasty actors.

Most people need only one dose of PPSV. A second dose is recommended for certain high-risk groups. People 65 and older should get a dose even if they have gotten one or more doses of the vaccine before they turned 65.

Common Questions

1. Does insurance cover these vaccines?
2. Yes, insurance policies including both vaccines

 

1. Which vaccine should I get first?
2. It depends…

• If this is your first pneumonia vaccine you would get the newer one (PCV 13) first;

Then 1 year later you would get the other vaccine (PPSV23)

• If you already had a prior vaccination with PPSV23 A dose of PCV13 should be given ≥1 yr after receipt of the most recent PPSV23 dose.

1. How often do these vaccines have to be given?
2. Immunity typically lasts for about 5 years. For those whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6-12 months after PCV13 and ≥5 yr after the most recent dose of PPSV23.

1. Does it cover all pneumonias?
2. No, there are lots of causes of pneumonia but the ones the vaccine protects against are most common and can be deadlier
3. Should I take it any time during the year?
4. This type of pneumonia can occur throughout the year so it should be given anytime during the year.

1. Can I take it along with flu vaccine?

Yes – the vaccines may be given together

1. Is it only for the elderly?
2. No, PPSV23 is recommended for:

• All adults 65 years of age and older,
• Anyone 2 through 64 years of age with certain long-term health problems,
• Anyone 2 through 64 years of age with a weakened immune system,
• Adults 19 through 64 years of age who smoke cigarettes or have asthma.

 

Table 1: Medical conditions or other indications for administration of PCV13, and indications for PPSV23 administration and revaccination for adults 19 years of age or older
Risk Group	Underlying Medical Condition	PCV13	PPSV23*
		Recommended	Recommended	Revaccination at 5 years after first dose
Immunocompetent persons	Chronic heart disease†		✓
	Chronic lung disease§		✓
	Diabetes mellitus		✓
	CSF leaks	✓	✓
	Cochlear implants	✓	✓
	Alcoholism		✓
	Chronic liver disease		✓
	Cigarette smoking		✓
Persons with functional or anatomic asplenia	Sickle cell disease/other hemoglobinopathies	✓	✓	✓
	Congenital or acquired asplenia	✓	✓	✓
Immunocompromised persons	Congenital or acquired immunodeficiencies¶	✓	✓	✓
	HIV infection	✓	✓	✓
	Chronic renal failure	✓	✓	✓
	Nephrotic syndrome	✓	✓	✓
	Leukemia	✓	✓	✓
	Lymphoma	✓	✓	✓
	Hodgkin disease	✓	✓	✓
	Generalized malignancy	✓	✓	✓
	Iatrogenic immunosuppression‡	✓	✓	✓
	Solid organ transplant	✓	✓	✓
	Multiple myeloma	✓	✓	✓

• ^*All adults 65 years of age or older should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine
• ^†Including congestive heart failure and cardiomyopathies
• Including chronic obstructive pulmonary disease, emphysema, and asthma
• ^¶Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
• ^‡Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy

Dr. Hilton is the President and CEO of Crown Care Hawaii, a local consulting firm providing patient advocacy and Medicare navigation services.  Before starting Crown Care, Dr. Hilton was in clinical practice as an internist with a subspecialty of infectious disease.  She is Professor of Clinical Medicine emerita at the Albert Einstein School of Medicine.

 

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