Do I 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 the elderly, has led to an 8 percent reduction in the numbers of deaths since 1999. With that being said, only around 65 percent of those at high risk has 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.

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 five and seven percent and can even be higher in the elderly.

There are two vaccines which 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.

The two FDA-approved vaccines immunize a person against the specific serotypes that are most likely to cause illness and invasive disease. They are:

• PCV13, marketed under the name Prevnar 13, which prevents 13 of the most severe types of S. pneumoniae
• PPSV23, marketed under the name Pneumovax 23, which protects against an additional 23 S. pneumoniae serotypes

Neither vaccine 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 PVC13 vaccine is 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).

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)
• Person recovering from surgery or a serious illness

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.

Pneumonia vaccination is a routine part of a child's immunization schedule. According to the CDC, all infants should be given four doses of PVC13 at two months, four months, six months, and between 12 through 15 months. Children who miss their shots or start late should still get vaccinated, the dosage of which will be adjusted based on age.

Adults in whom pneumonia vaccination is indicated should get both shots: first, the PCV13 shot and then the PPSV23 shot a year or so later.

If used as recommended, the vaccines should afford you lifetime protection. In those who have not completed the course, a booster shot may be recommended. Some doctors will also routinely offer their patients a booster shot five to 10 years after the initial series.

Side effects of both 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
• Drowsiness

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.