Adult Pneumonia Vaccination

What is Pneumonia?

Pneumonia is an acute infection of the lungs, most often caused by a virus or bacteria.

As it turns out, breathing is not optional. And fortunately, our lungs are awesome. We are constantly bombarded with microbes that manage to get into our lungs via our upper respiratory tract. But our body’s own defense mechanisms usually fight them off and maintain the sterile environment needed in the lungs so that we can preserve air exchange. Sometimes we are not able to fight off the infection, because the microbe is too strong, because our own body has a weakened defense, because our lungs are compromised, or because the amount of exposure was particularly impressive.

Of the 4 million cases of pneumonia annually in the U.S., the most common bacterial agent is Streptococcus pneumoniae. Symptoms usually start with sudden fever, cough, shortness of breath and possibly wheezing or pain in the side or chest. Some people will also have their shortness of breath progress to a faster breathing rate and lower oxygen level. While many people have mild disease and will recover without damage to their lung function, some patients will have complications. The infection can take over an area of the lung, leading to a big ol’ ball of pus where the lung should be, or travel to the heart, brain or joints. In severe illness where the infection from the lung gets into the blood stream, the mortality rate is over 25%.

 

How can you protect yourself?

Once again, you could live in a bubble. But that could be a general solution for just about all contagious problems. Keep it in mind, as I may forget to mention it in future posts.

As always, wash your hands, don’t put things in your mouth, don’t plant a big kiss on the coughing guy on the subway (unless it is John Travolta and this may be your only chance; some things are worth risking) – common sense, people!

 

A more realistic approach is vaccination. We used to recommend a single dose of pneumonia vaccine for adults aged 65 and older. This recommendation changed in 2014, and in order to improve immunity we recommend that adults get two different pneumonia vaccines: PCV13 (pneumococcal conjugate vaccine – Prevnar ®) and PPSV23 (pneumococcal polysaccharide vaccine – Pneumovax ®). These vaccines are given one year apart. If you haven’t started the series yet, start with the PCV13, followed by the PPSV23. But if you already received the previously recommended single dose of the PPSV23 (the recommendation before 2014), we can just update you with the PCV13 one year later.

Of course there are others besides those over age 65 who are at risk for pneumonia and its complications. People with medical conditions that put them at risk may need to be vaccinated sooner than age 65. Adults with the following medical conditions should speak with their provider regarding vaccination as they are at risk due to immune suppression: cancers, any immunosuppressive medical treatments (steroids, chemotherapy), organ transplant recipients, kidney failure/disease, HIV/AIDS, loss of spleen, sickle cell, cochlear implant, cerebrospinal leaks, immunodeficiencies. You’ll need additional an additional dose of PPSV23 when you reach age 65, as long as it has been 5 years since your previous PPSV23. You may need an extra dose of PPSV23 before age 65 but after 5 years anyway, depending on your medical condition and level of immune suppression, so make sure you and your provider review the immunization schedule. It’s can be a bit complicated, so consider politely asking them to bring out their copy of the immunization schedule to show you the footnotes (they are tiny and detailed and definitely worth reviewing to protect yourself) – it is available online if your provider doesn’t have one accessible in the office (http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html).

Adults with the following medical conditions should consider vaccination with PPSV23 before age 65: heart disease, asthma, COPD/emphysema, diabetes, alcoholism, cirrhosis, smoking.

 

I’m always disappointed with the number of people who have declined these vaccines in the past, thinking doctors are trying to trick them into something. No trickery here – intact safety data and lives saved. I’m just trying to keep you out of the hospital. I’d much rather spend my time being healthy than being hooked up to the IVs on the medical floor at the hospital. What about you?