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.