Why are there pneumonia vaccines?  Streptococcus pneumonia infection is the most common cause of bacterial pneumonia.  We know that older people often need hospitalization or they die from this type of bacterial pneumonia.  We added a pneumococcal conjugate vaccine to the childhood immunization schedules in 2000.  This led to herd immunity and a NINE-FOLD decrease in invasive pneumococcal disease in adults 65 and older.  Wow!

Timeline of 13-valent pneumococcal conjugate vaccine for older adults…

In 2014 the Advisory Committee on Immunization Practices (ACIP) expanded their recommendation for us to give the 13-valent pneumococcal conjugate vaccine (also known as PCV13 or Prevnar 13) to ALL patients older than 65, regardless if they had any risk factors.

Between 2014 and 2018 we have kept watch and despite 47% of Medicare patients older than 65 receiving PCV13 there has been no further decrease in noninvasive or invasive pneumococcal disease and no decrease in mortality from pneumonia.

ACIP met in 2019 and reviewed that information.  Now instead of suggesting PCV13 to ALL people older than 65 ACIP suggests that the patient and physician discuss IF this vaccine is appropriate for them.  Those at higher or highest risk for streptococcus pneumonia are still advised to get PCV13.

What are the risk factors that may lead to more dangerous infections due to streptococcus pneumonia?

1. The highest-risk group should still get PCV13 regardless of age. Chronic diseases (renal failure, nephrotic syndrome, chronic cerebral spinal fluid leak), treatment with immunosuppressant medications, B and T cell lymphocyte deficiency, HIV infection, phagocytic disorders, cancers of any type, leukemia, lymphoma, radiation therapy, anatomic or functional splenia, sickle cell disease, cochlear implants, multiple myeloma, solid organ transplant.
2. The group with higher risk (compared to the routine population) should consider shared decision-making with the patient’s physician. What are the higher risk conditions? Chronic heart, liver or lung disease, those living in a group situation (nursing home, assisted living facilities, jails, and shelters), prior pneumonia, those living near a high-rate of non-vaccinators, and substance abusers.

The vaccine is safe and effective at an individual level.  But, because of the decreased burden of pneumococcal disease from the monumental success of childhood vaccination, it decreases the benefit of the PCV-13 in older, well adults.

If a well 65 year old patient chooses to get the PCV13 vaccine, it should be given at age 65 and then the “other” pneumonia vaccine, PPSV23, is given a year later.  Medicare currently pays for the PCV13 vaccine.  If in the future Medicare denies financial coverage for the PCV13 vaccine, it may cost the patient about $200.

See your physician once a year for a well visit.  This is the perfect time to discuss screening tests and vaccines.