Studies Show Efficacy Of Pneumonia Vaccine In Older Adults
04 July, 2021
The pneumonia vaccine was first licensed in 1977. Pneumonia is a common lung infection that affects millions of people worldwide each year.
The most common bacterium causing pneumonia is pneumococcus . Its a microorganism that is spread through person-to-person contact. Although most of the infections it causes are mild, it can also cause very serious cases, especially in the elderly and children.
So much so that, in addition to pneumonia, it can lead to sepsis and meningitis. Therefore, in this article, well explain the importance of the pneumonia vaccine and its efficacy and safety.
How Many Doses Of Pcv13 Can An Adult Get In A Lifetime Who/when
CDC recommends adults receive 1 dose of PCV13, if indicated and if they have not received PCV13 previously . In addition, adults age 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant can choose to receive PCV13 based on shared clinical decision-making. However, if an adult received a dose of PCV13 prior to turning 65 years of age , they should not receive a dose of PCV13 when they turn 65.
Who Should Not Get The Vaccine
People should not get the vaccine if they have had a life threatening allergic reaction to a previous dose.
Additionally, a person should not undergo vaccination if they have had an allergic reaction to medication containing diphtheria toxoid or an earlier form of the pneumonia vaccination .
Lastly, people who are sick or have allergic reactions to any of the ingredients of the vaccine should talk to a doctor before getting the shot.
A pneumonia shot will not reduce pneumonia. However, it helps prevent invasive pneumococcal diseases, such as meningitis, endocarditis, empyema, and bacteremia, which is when bacteria enter the bloodstream.
Noninvasive pneumococcal disease includes sinusitis.
There are two types of pneumonia shots available. Which type a person gets depends on their age, whether or not they smoke, and the presence of any underlying medical conditions.
The two types are:
- Pneumococcal conjugate vaccine : Healthcare providers recommend this vaccine for young children, people with certain underlying conditions, and some people over the age of 65 years.
- Pneumococcal polysaccharide vaccine : Healthcare providers recommend this vaccine for anyone over 65 years of age, people with certain underlying conditions, and people who smoke.
According to the
- roughly 8 in 10 babies from invasive pneumococcal disease
- 45 in 100 adults 65 years or older against pneumococcal pneumonia
- 75 in 100 adults 65 years or older against invasive pneumococcal disease
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What Does Shared Clinical Decision
- PCV13 is a safe and effective vaccine for older adults. The risk for PCV13-type disease among adults aged 65 years is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects . The remaining risk is a function of each individual patients risk of exposure to PCV13 serotypes and the influence of underlying medical conditions on the patients risk of developing pneumococcal disease if exposure occurs.
- The following adults aged 65 years are potentially at increased risk of exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination, and providers/practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged 65 years who have not previously received PCV13:
- Persons residing in nursing homes or other long-term care facilities
- Persons residing in settings with low pediatric PCV13 uptake
- Persons traveling to settings with no pediatric PCV13 program
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.
Neurologic disorders
Chronic lung disease, including asthma
Chronic heart disease
Chronic liver disease
Endocrine and metabolic diseases
Non-malignant hematologic disorders
Cochlear implants
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Side Effects Of The Vaccines Against Pneumococcal Disease
Vaccines against pneumococcal disease are effective and safe, although all medications can have unwanted side effects.
Side effects from the vaccine are uncommon and usually mild, but may include:
- localised pain, redness and swelling at the injection site
- occasionally, an injection-site lump that may last many weeks
- low-grade temperature .
How Many Doses Of Ppsv23 Can An Adult Get In A Lifetime Who/when
CDC recommends some adults receive up to 3 doses of PPSV23 in a lifetime. Adults who have immunocompromising conditions should receive two doses of PPSV23, given 5 years apart, before age 65 years. Those adults should then receive a third dose of PPSV23 at or after 65 years, as long as its been at least 5 years since the most recent dose.
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Ward Off Pneumonia And Related Diseases
What to ask for: Prevnar 13 and Pneumovax two separate vaccines, which, when combined, provide greater protection again the pneumococcal bacteria that cause pneumonia, meningitis and bloodstream infections than either shot alone.
Who should get it: Anyone 65 or older. No matter what your age, you are also a candidate for the vaccine if you have chronic liver, heart or kidney disease, HIV, diabetes or alcoholism, or if you have cochlear implants or have had your spleen removed, Stewart says.
Why you need it: Older adults are more likely to come down with pneumonia and related illnesses. Once theyve contracted these illnesses, theyre also more prone to develop complications that can lead to serious health problems, hospitalization, and even death.
Whats involved: Two shots, taken a year apart.
Patients In Health Care Institutions
Residents of long-term care facilities should receive Pneu-P-23 vaccine. Refer to Recommendations for Use for information about pneumococcal vaccination of individuals at increased risk of IPD. Refer to Immunization of Patients in Health Care Institutions in Part 3 for additional information about vaccination of patients in health care institutions.
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Recommendations For Adults With Previous Ppsv23 Vaccinations
Adults 65 years of age or older who do not have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak and who have not previously received PCV13 may receive a dose of PCV13. Based on , clinicians and these older adults can discuss PCV13 vaccination to decide if it is appropriate. For those who choose to receive PCV13, give the dose of PCV13 at least 1 year after the most recent PPSV23 dose. Additionally, all adults 65 years or older should receive 1 dose of PPSV23 after age 65 years old regardless of their previous PPSV23 vaccination history. Doses of PPSV23 should be spaced 5 years apart from each other.
Adults 19 years of age or older who previously received one or more doses of PPSV23 should receive a dose of PCV13 at least one year after administration of the most recent PPSV23 dose if they have
- Immunocompromising conditions
- CSF leaks
- Cochlear implants
For those who require an additional dose of PPSV23, administer it no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
Pneumococcal Vaccine Timing for Adults pdf icon provides a summary of this detailed guidance.
Babies And The Pneumococcal Vaccine
Babies are routinely vaccinated with a type of pneumococcal vaccine known as the pneumococcal conjugate vaccine as part of their childhood vaccination programme.
Babies born on or after 1 January 2020 have 2 injections, which are usually given at:
- 12 weeks old
- 1 year old
Babies born before this date will continue to be offered 3 doses, at 8 and 16 weeks and a booster at 1 year.
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Side Effects And Safety
Serious side effects are very rare. Therefore, the benefit/risk balance is clear.
Pneumococcal conjugate vaccine may cause discomfort at the injection site. For example, redness, swelling, and pain. It happens in both children and adults. Nurses usually give the vaccine in the arm and thats where the discomfort occurs.
In some cases, the patient presents fever, tiredness, and general malaise. This includes poor appetite and headaches. In children, the fever is usually milder, but theyre more at risk of seizures from the fever.
On the other hand, the polysaccharide type vaccine can also produce these effects. Doctors associate it with a higher frequency of generalized muscle pain. However, in any case, the symptom is self-limiting.
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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.
Common And Local Adverse Events
Pneumococcal conjugate vaccine
Studies of Pneu-C-13 vaccine indicated that irritability decreased appetite increased or decreased sleep and pain, swelling and redness at the injection site after the toddler dose and in older children, are common side effects. Low grade fever occurred in 20% to 30% or more of vaccine recipients. In adults over 50 years of age, the most commonly reported side effects included pain at the injection site, fatigue, headache and new onset of myalgia, with fever above 38°C occurring in approximately 3% of vaccine recipients.
Pneumococcal polysaccharide vaccine
Reactions to Pneu-P-23 vaccine are usually mild. Soreness, redness and swelling at the injection site occur in 30% to 60% of vaccine recipients and more commonly follow SC administration than IM administration. Occasionally, low grade fever may occur. Re-immunization of healthy adults less than 2 years after the initial dose is associated with increased injection site and systemic reactions. Studies have suggested that re-vaccination after an interval of at least 4 years is not associated with an increased incidence of adverse side effects. However, severe injection site reactions, including reports of injection site cellulitis and peripheral edema in the injected extremity, have been documented rarely with Pneu-P-23 vaccine in post-marketing surveillance, even with the first dose. Multiple re-vaccinations are not recommended refer to Booster doses and re-immunization.
Vaccines Help Maintain Your Health
Vaccines have minimal risks and are generally very safe. Even healthy people need vaccines. Ask your health care provider about these vaccines at your next appointment to determine what is best for your preventative health.
Michelle Twombly, CNP, is a certified nurse practitioner at UH Family Medicine Center in Strongsville.
Concurrent Administration Of Vaccines
Pneumococcal vaccines may be administered concomitantly with other vaccines, with the exception of a different formulation of pneumococcal vaccine . There should be at least an 8 week interval between a dose of pneumococcal conjugate vaccine and a subsequent dose of Pneu-P-23 vaccine, and at least a 1 year interval between a dose of Pneu-P-23 vaccine and a subsequent dose of pneumococcal conjugate vaccine refer to Immunocompromised persons for information regarding administration of pneumococcal vaccines to HSCT recipients. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections. Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.
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:
People Who Should Receive The Pneumococcal Vaccine
A number of medical conditions put people at higher risk of pneumococcal disease and people with these conditions require immunisation.
You should speak with your doctor about whether you are at risk.
Pneumococcal immunisation is required for people who have:
- no spleen or have a spleen with poor function
- a weakened immune system includes people with immune deficiency, HIV infection, people receiving chemotherapy or radiotherapy, people who have received a transplant or people with a genetic immune deficiency
- leakage of fluid from around the spine and brain
- cochlear implants
It is also required for people who:
- smoke
- use alcohol to a harmful degree
- were born prematurely .
Strategies For Improvement And Future Developments
As mentioned above development of next-generation conjugated vaccines containing additional serotypes is ongoing. Early stage clinical trials showed that safety and immunogenicity of a 15-valent and a 20-valent conjugated vaccine were similar to that of PCV-13 in older adults . PCV-15 has been tested in Phase III trials in adults over 50 years of age and younger adults with various risk factors demonstrating immunogenicity when administered alone or concomitantly with influenza vaccine or followed by the 23-valent polysaccharide vaccine and has very recently been licensed in the US . Phase III trials for PCV-20 are ongoing in older adults . As serotype prevalence differs between children and older adults, partially due to serotype replacement processes, it might be advisable to consider the option of including different serotypes in vaccines for the different age groups.
The use of adjuvants has been successful for various protein-based vaccines, but has not yet moved beyond early development for polysaccharide or conjugate vaccines. Alum does not improve immune responses to T-cell independent antigens or conjugates , and various TLR agonists failed to increase antibody responses when co-administered with pneumococcal polysaccharides . Several adjuvants, such as IC31 or a combination of MPL and synthetic cord factor formulated as an oil-in water emulsion showed promising results in mouse models , but have not yet been tested clinically.
Medical Conditions Resulting In High Risk Of Ipd
Table 1: Medical Conditions Resulting in High risk of IPD
Non-immunocompromising conditions
IPD is more common in the winter and spring in temperate climates.
Spectrum of clinical illness
Although asymptomatic upper respiratory tract colonization is common, infection with S. pneumoniae may result in severe disease. IPD is a severe form of infection that occurs when S. pneumoniae invades normally sterile sites, such as the bloodstream or central nervous system. Bacteremia and meningitis are the most common manifestations of IPD in children 2 years of age and younger. Bacteremic pneumococcal pneumonia is the most common presentation among adults and is a common complication following influenza. The case fatality rate of bacteremic pneumococcal pneumonia is 5% to 7% and is higher among elderly persons. Bacterial spread within the respiratory tract may result in AOM, sinusitis or recurrent bronchitis.
Disease distribution
Worldwide, pneumococcal disease is a major cause of morbidity and mortality. The World Health Organization estimates that almost 500,000 deaths among children aged less than 5 years are attributable to pneumococcal disease each year. In Canada, IPD is most common among the very young and adults over 65 years of age.
Why Do I Need To Get These Shots
Shots help protect you from diseases that can be serious and sometimes deadly. Many of these diseases are common, but vaccines can prevent them.
Even if you have always gotten your shots on schedule, you still need to get some shots as an older adult. This is because:
- Older adults are more likely to get certain diseases.
- Older adults are at higher risk for serious complications from diseases.
- The protection from some shots can wear off over time.
Getting your shots also protects other people.
When you get shots, you dont just protect yourself you also protect others. This is especially important if you spend time around anyone with a long-term health problem or a weakened immune system .
Effectiveness Of The Pneumococcal Vaccine
Children respond very well to the pneumococcal vaccine.
The introduction of this vaccine into the NHS childhood vaccination schedule has resulted in a large reduction in pneumococcal disease.
The pneumococcal vaccine given to older children and adults is thought to be around 50 to 70% effective at preventing pneumococcal disease.
Both types of pneumococcal vaccine are inactivated or “killed” vaccines and do not contain any live organisms. They cannot cause the infections they protect against.