Summary Of Information Contained In This Naci Statement
The following highlights key information for immunization providers. Please refer to the remainder of the Statement for details.
Streptococcus pneumoniae is a bacterium that can cause many types of diseases including invasive pneumococcal disease , and community-acquired pneumonia .
For the prevention of diseases caused by S. pneumoniae in adults, two types of vaccines are available in Canada: pneumococcal 23-valent polysaccharide vaccine containing 23 pneumococcal serotypes and pneumococcal 13-valent conjugate vaccine containing 13 pneumococcal serotypes.
NACI has been tasked with providing a recommendation from a public health perspective on the use of pneumococcal vaccines in adults who are 65 years of age and older, following the implementation of routine childhood pneumococcal vaccine programs in Canada.
Information in this statement is intended for provinces and territories making decisions for publicly funded, routine, immunization programs for adults who are 65 years of age and older without risk factors increasing their risk of IPD. These recommendations supplement the recent NACI recommendations on this topic that were issued for individual-level decision making in 2016.
Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.
Asplenia or hyposplenia
Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic kidney disease and patients on dialysis
Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic lung disease, including asthma
Chronic heart disease
Chronic liver disease
Endocrine and metabolic diseases
Non-malignant hematologic disorders
Which Adults Should Get The Pneumococcal Vaccine
The following groups of adults should get both types of the pneumococcal vaccine :
- Adults 65 years and older because they are at high risk of pneumococcal infections
- Adults without a functioning spleen
- Adults who are immune compromised by disease, chemotherapy or steroids
- Individuals who are HIV positive
The following groups of adults should get the polysaccharide pneumococcal vaccine regardless of age:
- Adults who smoke or suffer from alcoholism
- Adults with heart or lung disease, liver disease, asthma, diabetes or cancer
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An Ounce Of Prevention Is Worth A Pound Of Cure
In the 1940s all of the strains of pneumococcus could be treated with the antibiotic, penicillin. However, over time many pneumococcal strains have become resistant not only to penicillin, but also to other antibiotics developed to combat bacterial infections. Resistance means that bacteria have changed, or evolved, so that they are no longer killed by one or more antibiotics. As a result, treatment with those antibiotics is not effective against those resistant strains.
Strains of pneumococcus have now been identified that are highly resistant to most antibiotics. Our reliance on and overuse of antibiotics have led to this resistance, backing us into a corner when treating infections caused by these and other types of bacteria. Unfortunately, we have taken our first steps into a post-antibiotic era. This makes the use of vaccines all the more important.
Whats The Difference Between Pcv13 And Ppsv23
|helps protect you against 13 different strains of pneumococcal bacteria||helps protect you against 23 different strains of pneumococcal bacteria|
|usually given four separate times to children under two||generally given once to anyone over 64|
|generally given only once to adults older than 64 or adults older than 19 if they have an immune condition||given to anyone over 19 who regularly smokes nicotine products like cigarettes or cigars|
- Both vaccines help prevent pneumococcal complications like bacteremia and meningitis.
- Youll need more than one pneumonia shot during your lifetime. A 2016 study found that, if youre over 64, receiving both the PCV13 shot and the PPSV23 shot provide the best protection against all the strains of bacteria that cause pneumonia.
- Dont get the shots too close together. Youll need to wait about a year in between each shot.
- Check with your doctor to make sure youre not allergic to any of the ingredients used to make these vaccines before getting either shot.
- a vaccine made with diphtheria toxoid
- another version of the shot called PCV7
- any previous injections of a pneumonia shot
- are allergic to any ingredients in the shot
- have had severe allergies to a PPSV23 shot in the past
- are very sick
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Available Vaccines And Vaccination Campaigns
A pneumococcal vaccine that protected against 14 different strains was licensed in 1977, and expanded to protect against 23 strains in 1983. This vaccine is a polysaccharide vaccine called PPSV23 . However, it is most effective in adults, and does not consistently generate immunity in children younger than two years old. A separate vaccine for children called PCV7 was licensed in 2000. PCV7 is a conjugate vaccine it was expanded to include protection against 13 strains in 2010, and renamed PCV13 . PCV13 protects against the bacterial strains responsible for the most severe childhood pneumococcal infections.
PCV7 was added to the recommended childhood vaccination schedule in 2000 . Since the initial recommendation, invasive pneumococcal disease in children has dropped by nearly 80% in the United States.
When To See A Doctor
A person who is over 65 years of age should talk to their doctor about which pneumonia vaccine may be best for them. The doctor can help determine whether they should get the vaccination, which vaccination to get, and when to get it.
Parents and caregivers of young children should talk to a pediatrician about the schedule for the pneumonia vaccination. The pediatrician can also address any questions or concerns about the safety and effectiveness of the vaccination.
A person does not need to see a doctor for mild reactions to the vaccine, such as tenderness at the injection site, fever, or fatigue.
However, if a person experiences any life threatening side effects, they should seek emergency help immediately.
Signs and symptoms of allergic reactions in children may include:
- respiratory distress, such as wheezing
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When To Get The Vaccine
Thereâs no such thing as pneumonia season, like flu season. If you and your doctor decide that you need to have a pneumonia vaccine, you can get it done at any time of the year. If itâs flu season, you can even get a pneumonia vaccine at the same time that you get a flu vaccine, as long as you receive each shot in a different arm.
Infants And Children Who Have Not Previously Received Pcv7 Or Pcv13
Indian Academy of Pediatrics recommends 3 doses at 6, 10 and 14weeks with a booster at15 mo. Infants receiving their first dose at age < 11 mo should receive 3 doses of PCV13 at intervals of approximately 4 weeks with a booster at 15 mo. Children Aged 1223 Months should receive 2 doses with an interval of at least 8 weeks between doses. Unvaccinated healthy children aged 2459 mo should receive a single dose of PCV13.
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Side Effects Of The Pneumococcal Vaccine
Like most vaccines, the childhood and adult versions of the pneumococcal vaccine can sometimes cause mild side effects.
- redness where the injection was given
- hardness or swelling where the injection was given
There are no serious side effects listed for either the childhood or adult versions of the vaccine, apart from an extremely rare risk of a severe allergic reaction .
How Much Do Pneumovax 23 And Prevnar 13 Cost
Pneumovax 23 and Prevnar 13 can be quite expensive without insurance. One dose of Pneumovax 23 currently costs around $135 cash price, while one dose of Prevnar 13 costs around $250 cash price. With a GoodRx coupon, you might be able to reduce your cost for these to around $90 and $195, respectively. Read here for information on how to use a GoodRx coupon for vaccines.
All health insurance marketplace plans under the Affordable Care Act, and most other private insurance plans, must cover pneumococcal vaccines without charging a copayment or coinsurance when an in-network provider administers the vaccine even if you have not met a yearly deductible. Medicare does not cover either vaccine.
Remember: The recommendations for who should get a pneumonia vaccination are based on risk factors and age, so be sure to talk to your doctor if you think you might need one. You should be able to receive both Pneumovax 23 and Prevnar 13 at your local pharmacy. Depending on which state you live in, these vaccines may not require a prescription. Be sure to reach out to your pharmacist for more information. The CDC has more information about these vaccinations here.
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What You Need To Know About Pneumonia And Flu Shots
This article was first published in The Montreal Gazette.
Recently, Oprah got pneumonia. Then she went on Ellen to recommend that everyone get their flu and pneumonia shots. Given that only 42 per cent of Canadians over the age of 65 got the pneumonia vaccine in 2016, maybe Oprah can get us over the 80 per cent target.
Sadly, Oprah has not always been a strong advocate for science. She gave a platform to Jenny McCarthy when she started claiming that vaccines caused her sons autism, and she also introduced the world to Dr. Oz.
But as Oprah explained to Ellen, pneumonia is no joke. Around 1.5 million people are hospitalized with pneumonia every year. Around 100,000 die in hospital and a third of people hospitalized with pneumonia die within the year.
Older patients are at greater risk and so are those with pre-existing lung disease. Smoking is also a risk factor for pneumonia, so if you need an extra incentive to stop smoking, this is it. But the main way to prevent pneumonia is with vaccines.
The problem with the pneumonia vaccine is not one of efficacy. A Cochrane meta-analysis of 18 randomized trials found that the pneumonia vaccine led to a substantial reduction in infections. The problem is which pneumonia vaccine to give people.
And if you wont listen to me, at least listen to Oprah.
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Vaccines For Adults And Seniors
The National Immunisation Program schedule provides free vaccinations for adults and seniors. You may need booster doses of some vaccines to maintain high levels of protection. Most vaccines are more effective if delivered at a specific age.
The following vaccines are provided free to adults and seniors aged 65 years and over:
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Future Strategies For Pneumococcal Immunisation Of Immunocompromised Hosts
Current PCVs do not provide protection against non-vaccine serotypes and can select for un-encapsulated S. pneumoniae strains. A number of extended serotype pneumococcal protein conjugates are under investigation in Phase 3 trials, including PCV15 and the 20 valent PCV . Such vaccines however are likely to overcome the problem of replacement serotype disease or the emergence of unencapsulated pneumococcal variants. Ultimately, a universal pneumococcal vaccine independent of serotype is required to address these issues. Promising universal vaccine candidates include S. pneumoniae killed whole cell vaccine , or pneumococcal antigens derived from highly conserved proteins or virulence factors . There is considerable interest in the application of nanoparticles and bacterium-like particles as vehicles to promote mucosal immune responses and to enhance the immunogenicity of candidate pneumococcal protein vaccines. In addition, strategies to improve the performance of current pneumococcal vaccines in the elderly include increased vaccine dose and the deployment of modern adjuvants . For example, adjuvant system AS02V enhances humoral and cellular immune responses to the pneumococcal protein PhtD vaccine in healthy young and older adults. Based on vaccines using conserved pneumococcal peptide sequences or lipoprotein antigens, the immunogenicity of peptide sequences will most likely be increased by novel antigen delivery systems and vaccine adjuvants .
How Can We Reduce The Number Of People Dying From Pneumonia
When we understand what risks can lead to pneumonia, we can find ways to reduce them. Furthermore, because a number of risks factors for pneumonia overlap with risk factors for other diseases, especially diarrheal diseases, interventions that target pneumonia have the additional benefit of helping to limit other diseases and saving more lives.
Vaccines against pneumonia
There are several versions of pneumococcal conjugate vaccine , which target different serotypes of S. pneumoniae the bacterium responsible for most cases of pneumonia.
The PCV vaccine is given to children younger than 24 months. According to a study by Cheryl Cohen et al. , PVC13 the currently recommended PCV vaccine version has 85% effectiveness against invasive infections caused by the specific strains the pneumococcal strainsincluded in the vaccine formulation.13
It has been estimated that if PCV13 coverage in low income countries would reach the coverage of the DTP3 vaccine, then PCV13 could prevent 399,000 child deaths and 54.6 million pneumonia episodes annually when compared with a world in which no pneumococcal vaccination was available.14 India which has the highest number of child deaths from pneumonia only introduced PCV13 in 2017 and the coverage is still very low clearly the pneumococcal vaccine still has a lot of potential.15
Another vaccine widely used to protect children against both pneumonia is the Hib vaccine.
Reducing air pollution
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Are You 65 Or Older Get Two Vaccinations Against Pneumonia
- By Gregory Curfman, MD, Assistant Professor of Medicine, Former Editor-in-Chief, Harvard Health Publishing
ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
If you or a loved one is age 65 or older, getting vaccinated against pneumonia is a good idea so good that the Centers for Disease Control now recommends that everyone in this age group get vaccinated against pneumonia twice.
This new recommendation is based on findings from a large clinical trial called CAPiTA, which were published today in The New England Journal of Medicine.
Streptococcus pneumoniae, sometimes just called pneumococcus, is a common bacterium that can cause serious lung infections like pneumonia. It can also cause invasive infections of the bloodstream, the tissues covering the brain and spinal cord , and other organs and tissues. Older individuals are especially prone to being infected by Pneumococcus, and these infections are often deadly.
The dark spots are pneumonia-causing Streptococcus pneumoniae bacteria isolated from the blood of an infected person.
One caveat is that while PCV13 is effective in preventing pneumonia caused by S. pneumoniae, it does not prevent pneumonia caused by viruses or other bacteria.
Who Should Get Prevnar 13 And Pneumovax 23
Prevnar 13 was developed for infants and children. The CDC recommends that all infants and children younger than 2 years of age get Prevnar 13. Prevnar 13 involves a series of four doses of the vaccine given at 2 months, 4 months, 6 months, and sometime between 12 and 15 months of age.
Pneumovax 23 is the vaccine used in adults. It does not work in infants and children under 2 years old.
Most adults do not need a pneumococcal vaccine until they reach the age of 65. Once a person turns 65 years old, the CDC recommends Pneumovax 23.
The same is true for any adult who smokes or has one or more of these chronic illnesses:
Chronic heart disease
Chronic lung disease, including asthma and chronic obstructive pulmonary disease
Chronic liver disease
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How Did Cdc Make The Decision To Recommend Pcv13 For Adults
CDC sets the adult immunization schedule based on recommendations from the Advisory Committee on Immunization Practices . ACIP used the Grading of Recommendations, Assessment, Development, and Evaluation approach or Evidence to Recommendations framework to evaluate evidence for PCV13 vaccination recommendations:
Aboriginal And Torres Strait Islander Adults And Seniors
Aboriginal and Torres Strait Islander people get additional free annual influenza vaccines and pneumococcal vaccine at 50 years of age through the National Immunisation Program.
Please see your doctor for advice on what you may need.
Generally, adults wont need boosters. We recommend you talk to your doctor if you are not sure:
- if you have had all the recommended vaccines
- if may need boosters
- if someone in your care may need additional vaccines or boosters.
Please note that the National Immunisation Program does not cover adults and seniors for missed or catch-up vaccines. You can buy additional vaccines privately when you need to.
Refugees and other humanitarian entrants of any age can get National Immunisation Program vaccines for free. This is if they did not receive the vaccines in childhood.
Check the National Immunisation Program schedule and talk to your doctor or immunisation provider if you have not had all the recommended childhood vaccinations.
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