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
What Are The Symptoms Of Pneumonia
The signs and symptoms of pneumonia can range from mild to severe. The symptoms depend on the type of germ that caused the infection, your age and overall health. Mild signs and symptoms of pneumonia are often similar the symptoms of a cold or flu, but the effects of pneumonia last longer.
Signs and symptoms of pneumonia may include:
- Chest pain when you breathe or cough
- Confusion or changes in mental awareness
- Cough, which may produce phlegm
- Fever, sweating and shaking chills
- Lower-than-normal body temperature
- Nausea, vomiting or diarrhea
- Shortness of breath
Newborns and infants may not show any sign or symptoms of the infection. However, they may vomit, have a fever, cough, be restless or tired, or have difficulty breathing and eating.
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
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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.
People With Medical Risk Factors
In addition to the 3 doses of 13vPCV routinely recommended for healthy non-Indigenous children < 5 years of age, children 12 months of age with risk conditions for pneumococcal disease are recommended to receive:
- An additional dose of at 6 months of age
- a dose of at 4 years of age
- a 2nd dose of at least 5 years after the 1st dose of 23vPPV
This is because of the higher disease burden and the possibility of lower antibody responses in these children.2-4
Aboriginal and Torres Strait Islander children diagnosed with risk conditions at 12 months of age who live in the Northern Territory, Queensland, South Australia and Western Australia already receive these extra doses as part of their routine schedule.
Any child aged 6 to 11 months with a newly identified risk condition who has not received an additional dose of 13vPCV at 6 months of age should receive this dose at diagnosis. The exception is children who have received a haematopoietic stem cell transplant these children are recommended to receive 3 doses of 13vPCV after transplantation, followed by 2 doses of 23vPPV
All children and adults with newly identified risk conditions are recommended to receive:
- 1 dose of at diagnosis (at least 2 months after any previous doses of 13vPCV
- or at 4 years of age whichever is later
- a 2nd dose of 23vPPV at least 5 years later
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The Different Types Of Pneumococcal Vaccine
The type of pneumococcal vaccine you’re given depends on your age and health. There are 2 types.
Pneumococcal conjugate vaccine is used to vaccinate children under 2 years old as part of the NHS vaccination schedule. It’s known by the brand name Prevenar 13.
Children at risk of pneumococcal infections can have the PPV vaccine from the age of 2 years onwards. The PPV vaccine is not very effective in children under the age of 2.
Can I Administer Ppsv23 And Pcv13 At The Same Office Visit
No, never give PPSV23 and PCV13 together. The recommended order for the two vaccines, if possible, is to give PCV13 first followed by PPSV23 later. The interval between administrations depends on the age of the patient, the indication for giving it, and which vaccine you administer first. See Pneumococcal Vaccine Timing for Adults pdf icon for additional details.
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How Does It Compare To Other Pneumococcal Vaccines
Like Prevnar 20, Prevnar 13 is a conjugate vaccine that works in a similar way to protect you against pneumococcal disease. Pneumovax 23, on the other hand, is a polyvalent vaccine that works by producing antibodies against pneumococcal bacteria.
No vaccine is 100% effective at preventing disease, but all three pneumococcal vaccines Prevnar 13, Prevnar 20, and Pneumovax 23 are considered safe and effective for helping protect against pneumococcal disease. And this latest FDA approval demonstrates ongoing pneumococcal vaccine development, with more candidates currently in the pipeline.
Lets review some key differences between the vaccines.
Impact On Pediatric Disease
PCV13 has provided substantial benefits since its introduction in 2010. To date, these benefits have been primarily in reduction of the incidence of invasive pneumococcal disease. Multisite population-based surveillance analyses revealed an overall reduction of 64% in invasive pneumococcal disease in children younger than 5 years of age. Additionally, a reduction in invasive pneumococcal disease was found to be 93% when researchers removed serotypes that were not contained in PCV7 from the analysis. The introduction of and subsequent vaccination in children with PCV13 resulted in a spillover effect as reductions in invasive pneumococcal disease were also seen in adults. The most recent Cochrane review of the effects of pneumococcal conjugate vaccines for preventing otitis media found modest beneficial effects in healthy infants given PCV7. This review encompassed 1995 to 2013 and reported that there were several ongoing randomized clinical trials studying the newly licensed PCV13 to establish its effects on acute otitis media.
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Adults At High Risk Of Ipd
Adults with immunocompromising conditions resulting in high risk of IPD, except HSCT, should receive 1 dose of Pneu-C-13 vaccine followed at least 8 weeks later by 1 dose of Pneu-P-23 vaccine, if not previously received. The dose of Pneu-C-13 vaccine should be administered at least 1 year after any previous dose of Pneu-P-23 vaccine. Refer to Immunocompromised persons for information about immunization of HSCT recipients.
Immunocompetent adults with conditions or lifestyle factors resulting in high risk of IPD should receive 1 dose of Pneu-P-23 vaccine, if not previously received. One dose of Pneu-P-23 vaccine is also recommended for all adults who are residents of long-term care facilities and should be considered for individuals who use illicit drugs.
Some experts also suggest a dose of Pneu-C-13 vaccine, followed by Pneu-P-23 vaccine, for immunocompetent adults with conditions resulting in high risk of IPD as this may theoretically improve antibody response and immunologic memory. However, Pneu-P-23 vaccine is the vaccine of choice for these individuals, and if only one vaccine can be provided, it should be Pneu-P-23 vaccine, because of the greater number of serotypes included in the vaccine.
Adults at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization.
Table 4 – provides recommended schedules for adult immunization with pneumococcal vaccines.
What If You Never Got Prevnar 13 As A Child
Lets say you never got a vaccine for pneumococcal bacteria when you were little . Most of you will just wait until you turn 65 years old, at which time, youll get Prevnar 13 followed by Pneumovax 23 at least 1 year later.
In certain cases, the timing may be different. Your provider will be able to advise you based on your specific situation.
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Global Epidemiology Since The Introduction Of Pneumococcal Conjugate Vaccines
Direct impact of PCV programmes on IPD in children
Reductions in IPD among target cohorts of children in high income countries have been similar for PCV10 and PCV7/13 in reported studies. Québec and Finland both used 2+1 schedules and observed 83 percent and 79 percent reductions in IPD in vaccine-eligible children, respectively. In England, using PCV7 then PCV13 in a 2+1 schedule, there was an estimated 5,000 fewer hospital admissions for bacteraemia, meningitis and pneumonia in children aged under 5 years over 12 years after the introduction of PCV7 and PCV13. The greatest reductions were seen in meningitis in children under 2 years age.
Direct impact of vaccination on non-invasive pneumococcal disease
The impact of pneumococcal conjugate vaccination on the large burden of noninvasive pneumococcal disease has been clearly demonstrated internationally in countries that have introduced these vaccines, particularly through reductions in childhood hospitalisations due to pneumonia. Other impacts, such as on acute otitis media, are less clear and more difficult to measure accurately. However, a systematic review found PCVs were associated with large reductions in risk of pneumococcal acute otitis media, but there was no evidence of benefit against allcause otitis media in high-risk children over 1 year of age or older children with a history of respiratory illness.
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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Medical Conditions Resulting In High Risk Of Ipd
Table 1: Medical Conditions Resulting in High risk of IPD
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.
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.
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
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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 38Â°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.
What Are The Possible Side Effects Of Pcv And Ppsv Vaccines
Kids may have redness, tenderness, or swelling where the shot was given. A child also might have a fever after getting the shot. There is a very small chance of an allergic reaction with any vaccine.
The pneumococcal vaccines contain only a small piece of the germ and so cannot cause pneumococcal disease.
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Why Is Pneumonia Dangerous What Are The Possible Complications Of Leaving This Condition Untreated
Pneumonia can usually be treated successfully without leading to complications. However, complications like the ones listed below can develop in some patients, especially those in high-risk groups.
Fluid or pus could get accumulated between the covering of the lungs and the inner lining of the chest wall this is called a pleural effusion . A chest tube may be needed to drain the fluid/pus.
Pus might collect in the lung area infected with pneumonia . Rarely this may require surgery.
Bacteria can spread to the bloodstream and other organs. This is a serious complication since the infection can cause the blood pressure to be dangerously low.
Although most people recover from pneumonia, it can be fatal in some cases. Approximately 5 to 10 percent of patients admitted to a general medical ward, and almost 30 percent of patients with severe infection admitted to an intensive care unit can die.