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Recommendation for Pneumonia Vaccine Revised

Prevnar 13 shot may no longer be necessary for healthy adults over 65

spinner image A person in medical gloves holds a syringe ready for injection of a shot of pneumococcal vaccine.

While pneumococcal disease is often mild, it can sometimes have serious and even deadly repercussions for those 65 years or older — particularly when the bacteria that causes it invade the lungs, causing pneumonia. Put in perspective: There were nearly 3,000 reported deaths from invasive pneumococcal disease (IPD) in 2014, the most recent year for which the Centers for Disease Control and Prevention (CDC) provides data.

The CDC has long recommended that in order to acquire the best protection against all strains of bacteria that cause pneumonia, all adults 65 and older should receive two pneumococcal vaccines: the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) followed by the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax) at a later visit.

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However, as of last week, the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, now recommends that PCV13 may not be necessary for healthy adults 65 and older — suggesting that the decision instead be left up to patients and their physicians to see if that extra prick would be appropriate. (The CDC typically accepts any guidelines suggested by the ACIP.)

A big reason for the shift? “A vaccination campaign among children succeeded in stopping the spread of the bacteria to the older age group,” says William Schaffner, M.D., medical director of the National Foundation for Infectious Diseases and professor of preventive medicine and infectious diseases at the Vanderbilt University Medical Center in Nashville, Tenn., as well as a member of the ACIP panel.

As he explains, since PCV13 was added to the vaccination schedule and routinely given to children starting in 2010, it's been hugely effective, with IPD in children dropping dramatically — by almost 80 percent — in the U.S. But it isn't just the little ones who have benefited. The vaccine indirectly protects adults by reducing their exposure to pneumococcal bacteria.

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"The children were often the carriers of the pneumococcus,” Schaffner says. “Through hugs and kisses and close association, they contributed their pneumococci to their elders. If the vaccine eliminates carriage, the elders no longer get sick from those 13 strains.” What's more, he adds, the subsequent recommendation, in 2014, to vaccinate seniors had no additional effect on disease rates.

However, the ACIP continues to recommend the pneumococcal vaccine, PPSV23, for adults over 65. Also, the new decision does not change the CDC's stance that both PCV13 and PPSV23 be given in a series for adults who are at an increased risk of pneumococcal disease.

"Anyone who reaches the age of 65, and is in any way immunocompromised or has any of the listed indications for pneumococcal vaccine because they're in a high-risk group — for example, if they have diabetes, heart disease or lung disease, or are a smoker — should continue to get both vaccines,” says Schaffner, who notes that this actually includes a substantial part of the older population.

The bottom line: Have a one-on-one with your M.D. “If your doctor would like to take the belt-and-suspenders approach by giving two vaccines, you can get those,” Schaffner says. “It's just not recommended as universal for healthy persons 65 or older. They've taken a half-step back. They didn't say, ‘Don't do it.’ They said, ‘You can think about it.’ ”

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Those choosing to get the vaccine should continue following the previous recommended schedule: a shot of PCV13, followed by PPSV23 one year later.