Medical Moment: Over 65? Do You Need 2 Vaccines?

07 Nov Medical Moment: Over 65? Do You Need 2 Vaccines?

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Dr. Heather Linder answers this week’s question: I’m over 65. Do I need two pneumonia vaccines?

Dr. Heather Linder

The Centers for Disease Control & Prevention (CDC) have made changes to the vaccine recommendations for adults 65 and older.

According to new vaccination guidelines, the CDC now recommends that adults age 65 and older receive two different types of pneumococcal vaccines. New guidelines recommend, upon turning 65, adults should now get Prevnar (that was previously recommended for children), followed by the traditional Pneumovax, 6-12 months later.

Here’s a little background: The Streptococcus pneumoniae bacteria (pneumococcus) is a leading cause of pneumonia, meningitis (infection of the lining around the spinal cord and brain) and bacteremia (blood stream infection) in adults. It can also cause less severe infections such as ear infections and sinus infections.

In the US, pneumococcus kills more people than all other vaccine-preventable diseases combined. The bacteria has over 90 different serotypes, but only a few of the serotypes actually cause invasive disease such as bacteremia and meningitis.

Pneumococcal pneumonia is the most common illness caused by the pneumococcus bacteria.

People with pneumococcal pneumonia usually have sudden onset of fever, chills, cough, shortness of breath and weakness. Each year about 300,000 adults, age 50 and older, are hospitalized because of pneumococcal pneumonia.

In about 25-30% of patients with pneumococcal pneumonia, the bacteria enters the bloodstream and causes bacteremia. The fatality rate from pneumococcal bacteremia is about 20% in adults and as high as 60% among the elderly.

There are two types of pneumococcal vaccines: Prevnar 13 and Pneumovax 23. Prevnar 13 protects against 13 types of pneumococcal bacteria and traditionally was only indicated for children age 6 weeks – 5 years. Pneumovax 23 protects against 23 types of pneumococcal bacteria and is indicated for adults 65 and older, as well as people age 19 and older who smoke or have chronic illness such as asthma, heart disease, alcoholism, diabetes, or immunodeficiency syndromes (HIV, cancer, absent spleen).

Studies have shown that Pneumovax 23 has been effective at preventing invasive disease (meningitis and bacteremia), but not as effective at preventing pneumonia as originally hoped. Therefore, researchers started studying Prevnar 13 in adults. Recent studies comparing people age 50 and older, who received Pneumovax 23 or Prevnar 13, showed that Prevnar 13 worked just as well or better than Pneumovax 23. Prevnar 13 induced an immune response for the serotypes that the two vaccines had in common that was either comparable or higher than the response with Pneumovax 23.

When Prevnar was given first, and followed by Pneumovax, the immune response was even greater. Therefore, the CDC now recommends that adults 65 or older receive both the Prevnar and Pneumovax, in that order.

Adults 65 and older who have not received a pneumococcal vaccine should get the Prevnar first and then a dose of Pneumovax 6-12 months later. Adults age 65 and older who have received the Pneumovax first should get Prevnar at least a year after their most recent Pneumovax.

With these new recommendations, Dr. Linder hopes we will see a decrease in the hospitalizations and deaths due to pneumococcal disease.

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