The second non-annual vaccination that is commonly recommended to adults over 65 are the pneumococcal vaccines. Earlier versions have been used in young children for several decades now and in 2014 the Centers for Disease Control’s (CDC) Advisory Committee on Immune Practices (ACIP) has recommended routine vaccination for adults over age 65 who are also more vulnerable to the disease causing forms of this bacteria.
What is the pneumococcal vaccine? This is an immunization that protects against a kind bacteria called streptococcus pneumoniae. It has 90 known serotypes (strains), but most live quietly in humans and do not cause disease. Some forms of this bacteria can cause sepsis or meningitis in certain cases (invasive pneumococcal disease or IPD), but most commonly cause bacterial pneumonia.
The pneumococcal vaccines reduce risk for pneumonia in older adults, but do not cover all strains of the disease causing bacteria.
The first pneumococcal vaccine was introduced in 1977. It wasn’t until 2014 that the ACIP recommended routine vaccination for all adults over the age of 65 with the PCV13. Then in September of 2015 they increased the recommendation to include a dose of PPSV23 to cover a broader spectrum of serotypes. The ACIP will revisit this recommendation in 20181 and will be monitoring efficacy of the new recommendation in the meantime. There is some potential to reduce the number of pneumococcal vaccines recommended for seniors in the future because of the herd immunity effect, due to successful reduction of pneumococcal disease in children through routine vaccination (herd immunity).
What are the symptoms? Symptoms can include fever, body aches, severe fatigue, cough and in a small percentage of cases sepsis and meningitis.
Why is vaccinating for pneumococcus recommended in adults over age 65?
Community Acquired Pneumonia (CAP) is caused by streptococcus pneumoniae 24-40% of the time and CAP causes close to 400,000 hospitalizations annually in the U.S. with at least 5% of those hospitalizations resulting in death2. One of the most concerning aspects of these infections is that they can come on very rapidly, which is part of why vaccination is recommended.
To make thing confusing there isn’t just one “pneumonia shot” like there is for other diseases. There are two vaccinations used: pneumococcal polysaccarhide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13). The CDC recommends both for adults over the age of 65. As of September 2015 the CDC approved the Advisory Committee on Immunization Practices (ACIP) recommendation of a single dose of PCV13 to be followed by a single dose of PPSV23 one year later. If a patient has received a dose of PCV13 prior to age 65 then it does not need to be repeated, but a dose of PPSV23 should be administered. If both have been given prior to age 65 then a second dose of PPSV23 is recommended after turning 65 if it has been at least 5 years since receiving the last dose. The reason the PCV13 is administered first despite PPSV23 having a larger number of protective strains, is that patients have a better immune response with this sequence than with vaccinating only with the PPSV23. PCV13 works via T-cell activation which lasts longer than the B-cell activation found in PPSV23. If you’ve had pneumonococcal disease it doesn’t necessarily protect you from future infection because there are at least 90 serotypes of streptococcus pneumoniae, leaving you open to infection with 89 others.
How effective is it? Efficacy for these vaccines is decent, for the strains that they cover. For adults over the age of 65 the PCV13 vaccine is 75% effective against invasive pneumococcal disease (meningitis and sepsis) and 45% effective against pneumococcal pneumonia3. The PPSV23 is at least 50% effective against invasive pneumococcal disease. Boosters after the initial recommended vaccinations are not currently recommended. Like all vaccines, immune response wanes with age so even though it helps, the protection conferred isn’t as strong as it is with children.
Medicare currently covers one pneumococcal shot and then a second one a year later, so both vaccines should be covered by most patients who have.
Bottom line: If you are over the age of 65 and live, work or socialize in environments where you are exposed to potential pneumococcus (like retirement communities or skilled nursing facilities) this is probably a good vaccine for you to have. The PCV13 creates a stronger and more long lasting immune response so if you only get one, prioritize that one. If you are otherwise healthy and live in a more traditional environment like a single family home, you might not need to vaccinate on the dot of your 65th birthday. Pneumonia can be successfully treated by a wide variety of therapeutics, naturopathic and allopathic, as long as it is recognized early. As always, please talk to your health care provider for more information about vaccinations.
Dr. Alethea Fleming, ND is a passionate advocate for naturopathic geriatric medicine. A 2007 Bastyr University graduate, she also earned a certificate in Gerontology from the University of Washington. Dr. Fleming is the owner and lead physician of the Vital Aging Clinic in Anacortes, Washington where she provides primary care to all adults as well as adjunctive geriatric care. Dr. Fleming is active in multiple community organizations as well as a member of WANP, AANP and OncANP. In her off hours, Dr. Fleming can be found hiking the beautiful trails of Fidalgo Island, spending time with her wonderful husband and son, or with her nose firmly in a good book.
References:
Tromp K, Campbell M, Vazquez A. Recent Developments and Future Directions of Pneumococcal Vaccine Recommendations. Clinical Therapeutics Vol 37. No. 5. 2015
Centers for Disease Control and Prevention. In: Atkins W, Wolfe S, Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th ed. Second printing. Washington, DC: Public Health Foundation; 2012.
van Werkhoven CH, Bonten MJ. The Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA): what is the future of pneumococcol conjugate vaccination in elderly? Future Microbiology 2015; 10 (9): 1405-13