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The pneumonia vaccine - explained - (2/27/2018)

By Dr. Ron Gasbarro

Mrs. Bailey, 65, came into the pharmacy looking puzzled. She said to the pharmacist, “I asked my doctor about getting the pneumonia vaccine but all she did was confuse me. Do I really need two different shots?” The pharmacist said that this is now the recommendation from the Centers for Disease Control and Prevention (CDC) and explained to her the importance of getting properly vaccinated against infections caused by pneumococcal bacteria.  

Each year in the US, pneumococcal disease causes thousands of infections, such as meningitis, bloodstream infections (bacteremia), pneumonia, and ear infections. Pneumococcal vaccines are very good at preventing severe disease, hospitalizations, and death. Presently, death from pneumonia is the eighth leading cause mortality in the US, killing over 50,000 people per year. The number of people who go to the emergency room is approximately 423,000 a year, states the CDC. 

Vaccines to prevent pneumonia have been evolving over the last few decades. Currently, there are 2 pneumococcal vaccines. The pneumococcal conjugate vaccine (PCV13; Prevnar 13®) protects against 13 types of pneumococcal bacteria. The CDC recommends PCV13 for use in infants and young children and adults 65 years or older. The pneumococcal polysaccharide vaccine (PPSV23; Pneumovax®23) protects against 23 types of pneumococcal bacteria. The CDC recommends it for all adults 65 years or older and for those 2 years or older at increased risk for disease. Children under 2 years of age should not receive the PPSV23 vaccine because it is not effective in that age group.  

Healthy adults age 65 and older should receive a dose of PCV13 first, followed 1 year later by a dose of PPSV23, advises the CDC. Mrs. Bailey asked the pharmacist why PCV13 is given before PPSV23 to adults age 65 years and older? Wouldn't PPSV23 protect against 10 additional strains of the bacteria? According to the Immunization Action Coalition (immunize.org), PCV13 is recommended to be given first because of the body's better immune response to the vaccine when given in this sequence. An evaluation of immune responses after a second pneumococcal vaccination administered 1 year after an initial dose showed that subjects who received PPSV23 as the initial dose had lower antibody responses after subsequent administration of PCV13 than those who had received PCV13 as the initial dose followed by a dose of PPSV23. Bottom line: PPSV23 works better when PCV13 is given first.

Those who are immunocompromised—patients with kidney disease, HIV, certain types of cancer, or no spleen—are indicated to receive 1 dose of PCV13 at 19 years or older and 1 or 2 doses of PPSV23 by age 64. Those aged 19-64 with diabetes or chronic heart, lung, or liver disease, as well as adults who smoke or are alcohol-dependent, should receive one dose of PPSV23. When they reach age 65, follow the well-adult pneumococcal vaccination schedule, which is to get PCV13 first, followed by PPSV23 at a minimum of 8 weeks later. If the person received PPSV23 before age 65, then he should receive PCV13 at least one year later. This should be followed by a dose of PPSV23 from 8 to 52 weeks later, depending on what the patient's insurance will allow. 

Mrs. Bailey, who has never received either vaccine, asked the pharmacist to administer the PCV13 vaccine that day and she would return to get the PPSV23 in a few months. 

Ron Gasbarro, PharmD is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com


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