Among the vaccines on your avoid-the-winter-crud checklist – flu, COVID, possibly respiratory syncytial virus – it’s also wise to ask your provider about the pneumonia vaccine.
Last fall, responding to a rise in pneumococcal infections in adults younger than 65, the Centers for Disease Control and Prevention lowered the recommended age to 50 for getting this shot. The change pertains to adults who have not previously received the pneumococcal conjugate vaccine (PCV).
Brian Montague, DO, MS, MPH, professor of medicine in the Division of Infectious Diseases at the CU Anschutz School of Medicine, strongly recommends the PCV vaccine to patients who are at risk. In his practice, which includes transplant patients and other immunocompromised patients, the vaccine is standardly recommended.
In his role as medical director for occupational health at CU Anschutz, vaccine questions for campus personnel frequently come his way. In this context, Montague said, “When these vaccine questions come up, we encourage people to follow CDC recommendations.” This includes the pneumococcal vaccination for individuals starting at age 50.
Previously, he said age 65 had been considered a “sweet spot” for pneumococcal vaccination because that’s when the risk of disease is increasing and the immune system remains hearty enough to respond to the vaccine.
Recent data, however, showed pneumonia rates climbing in the 50-to-64 age group, along with increased severity, especially in the African American community. In review of data from a national registry, Montague observed that about a third of the overall cases diagnosed as the more-severe invasive pneumococcal disease – including bloodstream infections and meningitis – fell into the 50-to-64 age group. “That third is an approximate number, but it tells you that if you just vaccinated people at 65, you would lose the opportunity to prevent a significant portion of those cases,” Montague said.
"It has good efficacy against strains that were not covered in prior PCV vaccines. We see invasive pneumococcal disease in that 50 to 65 age group. You're going to help people. You're not putting them at significant risk with the vaccine." – Brian Montague, DO, MS, MPH
Because there are several PCV vaccines available, the specific shot given is based on a person’s age, vaccination history and medical history. About 25% of adults aged 18 and older have received a PCV shot, according to the CDC.
The agency notes that most pneumococcal infections are relatively mild, but some can result in long-term health problems, including brain damage or hearing loss. More severe cases can lead to death.
When new strains of the streptococcus pneumoniae bacteria emerge, providers determine which PCV, or numbered serotype, is best matched to a patient’s risk factor. Adults who are approaching or in the 50-to-64 age group likely received the seven-serotype vaccine as a child, Montague said. Adults currently receive a 20-serotype vaccine – or 20 strains covered – which is the PCV available to Colorado adults. It is expected that as new strains of bacteria emerge, newer vaccines which cover more of these new bacteria will be developed. “Particularly if you’re an immunocompromised person who needs every bit of protection, then when the new vaccines come out, ‘You should get that,’” Montague said.
The CDC recommends consulting with your provider to determine which type of PCV, and how many doses, should be given. In general, it recommends PCVs to these groups:
Side effects from the vaccine are generally a sore arm and possibly a slight fever and some achiness. “It’s not a high-risk vaccine,” Montague said. “It has good efficacy against strains that were not covered in prior PCV vaccines. We see invasive pneumococcal disease in that 50 to 65 age group. You’re going to help people. You’re not putting them at significant risk with the vaccine.”
People with lung disease as well as weakened immune systems are more susceptible to pneumococcal infections and greater severity of disease. Montague said people with liver disease are also more at risk because the liver makes many of the proteins that regulate the body’s immune response. Other risk factors of getting pneumonia include heart disease, chronic kidney disease and diabetes.
A meeting of the Advisory Committee on Immunization Practices that noted racial disparities in adults at greatest risk for pneumonia was another contributing factor to the lowered PCV adult age range.
“This probably relates to other comorbidities, but the peak age groups for people getting pneumococcal disease amongst African Americans was a younger age than amongst Caucasians,” Montague said. “For Caucasians, if you waited until 65 to give the PCV, you missed fewer people. For African Americans, they were actually peaking (for risk) in their 50s, so the previous vaccine recommendation for 65-plus disproportionately missed disease in the African American community.”