Do I Need Two Pneumonia Vaccines?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Yes, if you are over 65 you do. These recommendations changed in the United States in September 2014 and I would call them a sweeping change. Pneumococcal vaccines don’t protect you from ALL pneumonia but they do protect you from Strep pneumococcal infections including pneumonia and meningitis which remain an important source of illness and even death among older adults.

What’s new? For all adults ≥ 65 years of age, there are two recommend pneumococcal vaccinations (booster shots). Vaccination now consists of two vaccines: Pneumovax 13 (aka Prevnar 13) AND Pneumovax 23.

What were the old recommendations? Until September of this year if you are over 65 you received the 23-valent pneumococcal polysaccharide vaccine (Pneumovax 23). Now you need TWO pneumonia vaccines. In September 2014, the United States Advisory Committee on Immunization Practices (ACIP) began also recommending the pneumococcal conjugate vaccine (Pneumovax 13/Prevnar) for all adults ≥ 65 years of age.

Do I get them at the same time? Current recommendations for individuals ≥ 65 years of age who have not previously received either vaccine are to get them as follows: first Pneumovax 13, followed 6 to 12 months later by Pneumovax 23. In patients who have already received Pneumovax 23, at least one year should elapse before they are given Prevnar (Pneumovax 13).

Why did we change this, do we really need more vaccines? The revision was prompted by results from a huge clinical trial. After looking at 85,000 adults ≥ 65 years of age in the Netherlands, it was found that Pneumovax 13 protected older folks against pneumococcal pneumonia.

Is there debate here? Yep, a little. Know this: infants here in the United States routinely get Prevnar (Pneumovax 13) and in the Netherlands they didn’t at the time of this study. So, some concern has been raised that since this trial began before pneumovax 13 was used routinely in infants in the Netherlands, it might not answer the question of whether its use in adults is efficacious in countries that routinely vaccinate infants . . . like ours.

Dr O.

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