Do You Need the Pneumonia Vaccine?

Pneumonia causes over 50,000 deaths in the U.S. every year and accounts for over 400,000 emergency room visits, according to a report from the Centers for Disease Control and Prevention (CDC).

In recent years, the increased use of pneumonia vaccines, particularly among older people, has led to an 8% reduction in the numbers of deaths since 1999. With that being said, only around 65% of those at high risk have been properly vaccinated.

In many cases, people are unsure whether they need the vaccine or which type of pneumonia it is meant to prevent. Others are not even aware a vaccine exists.

Types of Pneumonia

Pneumonia is defined as the inflammation of the air sacs of the lungs which can fill with fluid and lead to breathing difficulty, fever, chills, and coughing with pus or phlegm. Pneumonia is most commonly caused by germs but can also develop if you inhale food or liquid into the lungs (aspiration pneumonia) or pick up a drug-resistant bacteria while in the hospital (hospital-acquired pneumonia).

The most common type is known as community-acquired pneumonia in which a contagion such as a bacteria, virus, or fungi is spread outside of a healthcare setting. Of these, bacteria is by far the most common cause.

Bacterial pneumonia is typically spread by respiratory droplets that are aerosolized once a person coughs or sneezes. The majority are caused by Streptococcus pneumoniae, a bacterium with more than 90 different serotypes. Of these, 10 types are responsible for the majority of pneumonia-related complications.

While bacterial pneumonia primarily affects the respiratory tract, it can cause serious illness if it spreads into the bloodstream. If this happens, it can infect the blood (pneumococcal bacteremia/sepsis) and cause inflammation of the membranes surrounding the brain and spinal cord (pneumococcal meningitis). The risk of death in people with invasive pneumonia is between 5% to 7% and can even be higher in older persons.

Types of Pneumonia Vaccine

Four vaccines can provide protection against Streptococcus pneumoniae. They cannot prevent other types of bacterial pneumonia (such as those caused by Chlamydophila pneumoniae or Mycoplasma pneumoniae) or any associated with a fungus or virus.

These four FDA-approved vaccines immunize a person against the specific serotypes that are most likely to cause illness and invasive disease:

• PCV13 (Prevnar 13) prevents infection caused by 13 of the most severe types of S. pneumoniae
• PCV15 (Vaxneuvance) protects against 15 S. pneumoniae serotypes
• PCV20 (Prevnar 20) helps prevent infection caused by 20 of the most severe types of S. pneumoniae
• PPSV23 (Pneumovax 23) protects against an additional 23 S. pneumoniae serotypes

None of these vaccines is made from a live or whole bacteria but rather parts of the bacterial shell. While these components cannot cause disease, the immune system recognizes them as threats and triggers a defensive response in the same way it would to a real bacteria.

The PCV13, PCV15, and PCV20 vaccines are delivered intramuscularly either into the deltoid muscle of the upper arm or the vastus lateralis muscle of the external thigh. The PPSV23 shot can either be given intramuscularly or subcutaneously (into the skin).

Who Needs Vaccination?

Pneumonia vaccination is not recommended for everyone. The vaccines are primarily used in persons who are at increased risk of serious illness. These include:

• Infants and children as part of their routine vaccination schedule
• Persons over the age of 65
• Persons with compromised or weakened immune systems, including those with chronic illness such as HIV, heart disease, liver disease, kidney failure, and diabetes
• Organ transplant recipients and person undergoing chemotherapy, both of whom have weakened immune systems and exposure to immune suppressive drugs
• Persons with chronic respiratory illnesses such as asthma, emphysema, chronic obstructive pulmonary disease (COPD)
• Persons who smoke (who have an underlying risk of lung infection) or are heavy drinkers (who are more likely to have a suppressed immune system)

Vaccination is currently not recommended for persons between 18 and 64 who are healthy. The same applies to anyone who has had a prior allergic reaction to the vaccine or has a known allergy to any of the components of the vaccine.

Vaccination Recommendations

Pneumonia vaccination is a routine part of a child's immunization schedule. Here are recommendations for which vaccines should be given to which populations, according to the CDC:

PCV13 (Prevnar 13) is recommended for:

• Children younger than 2 years old
• Children ages 2 to 18 years with certain medical conditions

PCV15 (Vaxneuvance) or PCV20 (Prevnar 20) is recommended for:

• Adults 65 years or older
• Adults ages 19 to 64 years with certain risk factors or medical conditions

PPSV23 (Pneumovax23) is recommended for:

• Children ages 2 to 18 years with certain medical conditions
• Adults 19 years and older who get the PCV15 vaccine

If used as recommended, the vaccines should afford you lifetime protection.

Side Effects

Side effects of these vaccines tend to be mild and resolve on their own within one or several days. Most are related to injection site discomfort or manifest with mild, flu-like symptoms. Among the most common symptoms:

• Fatigue
• Headaches
• Low-grade fever
• Muscle pain (myalgia)
• Joint pain (arthralgia)
• Injection site pain, redness, swelling, or tenderness
• Chills

Less commonly, diarrhea, vomiting, or a skin rash can occur.

In the event of a more severe reaction—including hives, blisters, breathing restriction, facial swelling, tongue swelling, confusion, or seizure—call 911 or go to your nearest emergency room immediately. While rare, an all-body allergic reaction (anaphylaxis) can occur which, if left untreated, can lead to shock, coma, and even death.