Posted by: notdeaddinosaur | January 15, 2015

Senior Immunization Update

First patient this morning began with a question:

What’s this new coxie vaccine something-or-other I’ve been hearing about? Can you explain that to me?

Cox? Oh, you must mean Pneumococcus. Yes, I can explain that:

There’s a very common germ that lives on our skin and in our noses, and usually doesn’t cause us any trouble. It’s full name is streptococcus pneumoniae, but we usually call it by its nickname: Pneumococcus. It originally got the name because it’s a fairly frequent cause of pneumonia (lung infection), though it also causes other kinds of infections, like skin, bloodstream, and lining of the brain (meningitis.)

There are different strains of this germ that are exactly alike except for different antigens (proteins, sugars, or some combination of the two) on their surface. We call those “serotypes” and they’re important because it’s how our body recognizes them, and protects us from them by making antibodies; separate antibodies for each serotype.

There are several vaccines that have been approved against pneumococcus. One is called Pneumovax (which most people refer to as the “pneumonia shot”, but it’s against the germ, not the disease. You can still get pneumonia from other germs, and the shot protects against pneumococcal infections other than pneumonia), and it protects against 23 different strains. It’s currently recommended for everyone at age 65, and for some people younger than that who are at higher risk for pneumococcal infections. There’s another called Prevnar that contains 13 different antigens (12 of which are also in Pneumovax) but because it’s made a little differently (“conjugated”) it’s more effective. (It produces a stronger immune response, meaning higher antibody levels.) Prevnar was first approved for infants and young children to protect them from meningitis caused by pneumococcus, but is now also recommended for adults.

So what does that mean for Pneumovax? Are you still supposed to get it? Are you supposed to get both? When?

Here are the new recommendations?

  • Healthy people (defined as not having another indication for pneumococcal vaccination) should get Prevnar (PCV13) at age 65, and then 6-12 months later should get Pneumovax (PPSV23).
  • If you’re over 65 and have already gotten a dose of Pneumovax at least 6 months ago, you should get Prevnar now.
  • (There’s a slightly more complicated algorithm if you got Pneumovax before age 65.)

To which my patient replied:

That makes a lot more sense.

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Responses

  1. So I need another shot? Not sure when another visit with you will be covered. Miss you, Margaret

  2. Thank you. You just saved me a few minutes in my doctor’s office.

  3. In 2000 I received a pneumonia shot and was told it was my “lifetime last”. So, it has done its duty for the past 14 years but is the “lifetime last” still correct? (Yes, I’m over 65.)

  4. I’m confused as well. Does anyone with indication for Pneumovax need Prevnar, even if way under 65? I can’t ascertain that from the CDC recommendations. I receive Pneumovax because I’m a brittle asthmatic ER nurse. If I need Prevnar, I’ll be first in line, especially now that I work with little humans. Please don’t tell me to ask my PCP–she tells me I’m “above her paygrade” level of complexity.

  5. xCOG: Yes, you should get a dose of Prevnar now to boost your antibody response to the previously received Pneumovax dose. It’s still “once per lifetime over 65” pneumococcal vaccination, except now it’s a 2-shot series (one of each Prevnar and Pneumovax) given 6-12 months apart.

    Jennifer: Technically, you don’t need Prevnar until age 65. But based on my reading of the studies, if I were in your “brittle asthmatic” body, I’d get it. Can’t hurt; could very well help. Bear in mind, too, that they plan to revisit these recommendations in 2018. Wouldn’t you hate to have them advise you to have it only to have died of pneumonia the year before?

  6. Your explanation does make sense. However, in my area, Medicare and the Medicare Advantage plans are very ambivalent/ambiguous about whether and in what circumstances they will pay for Prevnar. So my advice to patients right now is to hang back until we get a straight answer (unless they agree in writing to pay for it if Medicare doesn’t).

  7. Great article on immunizations for seniors. I posted it on my FB page here https://www.facebook.com/Agingyourwayinc. Aging Your Way provides in-home service coordination services for seniors that qualify for the Aging Waiver in Pennsylvania. Feel free to check out the site and post any links you want regarding seniors.

    Erin


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