Your Guide To Adult Vaccines
En español | It's a nasty one-two punch: The influenza virus, which makes you reach for fistfuls of tissues and sends you crawling under the covers, can also find its way into your lungs, turning into something much worse — pneumonia.
According to the Centers for Disease Control and Prevention (CDC), more than 250,000 people in the U.S. have to seek care in a hospital because of pneumonia each year. And pneumococcal pneumonia kills approximately 1 in 20 older adults who get it, the CDC reports.
Before the pandemic, pneumococcal pneumonia, caused by a bacterial infection, killed more people in the U.S. every year than all other vaccine-preventable diseases combined. People 65 and older are particularly at risk because as we age, our immune system isn't able to fight off these infections.
The flu, pneumonia and inflammation create a deadly threat
“Pneumococcal pneumonia can follow other viral infections, particularly influenza,” says William Schaffner, M.D., an infectious disease specialist at the Vanderbilt University School of Medicine. The biology behind it: The flu virus attaches to, and infects, the cells lining the mucous membranes in the back of the throat, nose and bronchial tubes. Normally, the cells eject infectious agents out of the body via the nose or mouth, or they're simply swallowed. But when impaired by the flu, the cells lining these membranes allow the bacteria to slip down into the bronchial tubes and trigger a secondary infection, in the lungs. The infection inflames the air sacs in the lungs, causing them to fill with pus and fluid. That not only makes it hard to breathe but can allow bacteria to escape into the bloodstream, causing an infection called sepsis, an aggressive inflammatory response that can, ultimately, lead to organ failure.
Pneumococcal pneumonia, of course, is also likely be a complication of respiratory syncytial virus (RSV), a common and highly contagious winter lung infection, which—uncharacteristically—spread this summer, and SARS-CoV-2, the virus that causes COVID-19. However, the pneumococcal vaccine won’t shield you from pneumonia that results from either of them. As Schaffner puts it, “Pneumonia from Covid is a different sort of pneumonia.”
What it’s still important so to get the shot? “Pneumococcal pneumonia, particularly in people 65 and older, has a high case-fatality rate, even with appropriate antibiotics,” says Gregory Poland, M.D., an infectious disease expert and director of the Mayo Clinic's Vaccine Research Group.
Studies show that rolling up your sleeve and taking a little needle discomfort can reduce your risk of illness by as much as 40 to 60 percent, helping you avoid a hospital visit — especially important this season, with the flu potentially raging alongside the coronavirus. “It's important for your own personal protection and will take some of the burden off an already overwhelmed health care system,” says Schaffner.
Who needs one, or two, pneumonia vaccines
There are two pneumococcal vaccines, each working in a different way to maximize protection. PPSV23 protects against 23 strains of pneumococcal bacteria. “Those 23 strains are about 90- to 95-plus percent of the strains that cause pneumonia in humans,” Poland explains. PCV13, on the other hand, is a conjugate vaccine that protects against 13 strains of pneumococcal bacteria. “PCV13 induces immunologic memory,” he says. “Your body will remember that it has encountered an antigen 20 years from now and develop antibodies to fight it off.”
In order to get the best protection against all strains of bacteria that cause pneumonia, the CDC has long recommended that everyone 65 or older receive both vaccines: PCV13 (or Prevnar 13), followed by the pneumococcal polysaccharide vaccine (PPSV23, or Pneumovax) at a later visit. But the agency is now saying that PCV13 may not be necessary for healthy people 65 and older, suggesting that the decision be left up to patients and their physicians as to whether that extra skin prick is appropriate. (This does not change the CDC's stance, though, 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.
Two new pneumococcal vaccines have been approved by the FDA and are expected to be released this season. The CDC Advisory Committee on Immunization Practices is meeting in October to make recommendations about who should be getting them. Prevnar 20, from Pfizer, protects against 20 strains, including seven strains that account for 40 percent of pneumococcal disease cases and deaths in the U.S. Merck has a new 15-valent conjugate vaccine, Vaxneuvance, that protects against 15 strains.
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What to know about the pneumococcal vaccine
Who needs it: The CDC recommends one pneumococcal vaccine (PCV13) for adults 19 to 64 with certain risk factors (such as being a smoker or having health conditions like chronic lung or heart disease, leukemia, lymphoma or alcoholism). If you work around chronically ill people — say, in a hospital or nursing home — you should get the vaccine, even if you're healthy. People 65 and older can discuss with their health care provider whether they should get PCV13 if they haven't previously received a dose. A dose of PPSV23 is recommended for those 65 and older, regardless of previous inoculations with pneumococcal vaccines.
How often: Space immunizations out. You should receive a dose of the pneumococcal conjugate vaccine (PCV13), then, a year later, a dose of pneumococcal polysaccharide vaccine (PPSV23). People with any of the risk factors should get one dose of PCV13 and PPSV23 before age 65, separated by eight weeks.
Why you need it: Pneumococcal disease, which can cause pneumonia, kills around 3,000 people a year. Young children and those over 65 have the highest incidence of serious illness, and older adults are more likely to die from it.
Editor’s note: This article was published on Oct. 26, 2020. It was updated in September 2021 with new information.