Dr. Drew Werner
newsroom@vaildaily.com
VAIL CO, Colorado

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November 26, 2012
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Vail Dear Doc column: Should you get a pneumonia vaccine?

The long and fascinating history of medicine has benefited humankind more than any other scientific endeavor. Am I biased? Of course. Nevertheless, medicine has impacted virtually every person on this planet.

The three main contributions of medicine are the ideas of disease prevention, germ theory and the importance of cleanliness and, perhaps most of all, the widespread use of vaccinations against disease. It is no wonder then that I spend a lot of time talking about one of those topics in some way or another.

Dear Doc,

with your recent and ongoing recommendation based on medical and scientific studies to get a flu shot annually, what are your thoughts about getting the pneumonia vaccine (i.e. pneumovax)? What age group should consider this additional vaccine? Are there any significant side-effects to be taken into consideration for potential recipients?

- A Nurse at the Beav

Dear colleague at the Beav,

That is an interesting and timely question. Locally our population is aging, and the pneumovax is often given with the flu vaccine. Like all vaccines, the pneumonia vaccines prevent only those specific diseases they are designed to build immunity against. Pneumococcal vaccines help our bodies build immunity against a form of bacteria in the Streptococcal family (think strep throat, which is a distant relative) called Streptococcal Pneumoniae or Pneumococcus. That immunity allows our bodies to rapidly develop an immune response to an exposure to the bacteria and prevent its spread and thus infection.

There are two types of pneumonia vaccines. The first pneumococcal vaccine was actually developed in 1945. Although effective, it coincided with the arrival of penicillin, which was an effective antibiotic for pneumococcal disease. Likely because of that, it was never widely made available. Later, in 1970, a newer version of the pneumovax vaccine was introduced, which then contained antigens against 14 different forms of pneumococcus. In 1983, our current pneumococcal vaccine was developed, which contains antigens against 23 different forms of pneumococcus. Although there are more than 90 types of pneumococcal bacteria, the 23 types of bacteria the vaccine protects against cause the great majority of pneumococcal infections.

More recently, it was found that pneumococcal infections pose very serious risks to infants and children. While pneumonia may be the most common consequence of infection in adults, infections in the young are often a life threatening form of meningitis. The adult pneumococcal vaccine is a polysaccharide vaccine. That means it contains a polysaccharide antigen of the capsule of the bacteria against which it provides immunity. Unfortunately, infants under 2 years of age do not develop very good immunity when given this vaccine. For that reason a special vaccine called pneumococcal conjugate vaccine (PCV13) was developed for them. It offers protection against 13 forms of pneumococcus compared to the 23 in the polysaccharide vaccine (PPSV23).

A conjugated vaccine has the polysaccharide antigen conjugated or attached to a helper protein. This results in a different immune response from the body, and results in a many times greater immune response in infants. There is also a slight difference in the types of pneumococcal bacteria the two vaccines protect against. Most importantly, the PCV13 prevents several types of pneumococcal bacteria, which cause ear infections (otitis media) in children.

Why is all this important? The answer may surprise you. In the United States, the Center for Disease Control and Prevention (CDC) estimates that pneumococcal infections cause 4 million infections every year! That leads to 445,000 hospitalizations and 22,000 deaths. Like most infectious diseases, those most likely to be seriously ill or die from infection are the very young (under 2 years old) and senior citizens over the age of 65.

Not surprisingly, immunization is targeted at these age groups. The recommendations are that the PCV13 vaccine be administered to all children under the age of 5. Most importantly is the recommendation of early vaccination as a series at 2, 4, 6 and 12 to 15 months of age. The PPV23 vaccine is recommended for all adults over age 65, as well as individuals between age 2 and 65 with underlying medical conditions that impair the immune system or who have chronic diseases such as renal failure and respiratory disease. Anyone who does not have a functioning spleen, or who has had an injury requiring removal of their spleen, should also be vaccinated with PPV23.

The pneumonia vaccine, whether the pediatric PCV13 or adult PPV23 may not prevent all forms of pneumonia or meningitis, but they are very effective against the most serious strains of pneumococcal bacteria and preventing the 4 million infections it causes each year. Talk to your doctor and see if vaccination is right for you. The side effects are minimal. In children, PCV most commonly causes mild, brief drowsiness, swelling at the injection site and fussiness or irritability with a low grade fever (less than 102 F). Adults who receive the PPV23 vaccine may experience redness or pain where the shot is given and less than 1 in 100 people develop fever, muscle aches or a more significant reaction.

Dr. Drew Werner is a medical staff leader at Valley View Hospital in Glenwood Springs, a family physician at TotalHealth Care and the Eagle County health officer. He lives in Eagle with his family. Email comments about this column to cschnell@vaildaily.com.


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The VailDaily Updated Nov 26, 2012 05:04PM Published Nov 26, 2012 05:01PM Copyright 2012 The VailDaily. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.