A lot of confusion about who gets vaccinated with the 23-valent pneumococcal vaccine. I put together this article to help clarify some of the common questions.
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide
There is no contraindication to give pneumovax at hospital admission.
Invasive pneumococcal disease is the most common vaccine preventable disease worldwide. 40,000 deaths are attributable to invasive pneumococcal disease in the US annually.
Current 23-valent polysaccharide vaccine covers 95% of the most common causes of invasive pneumococcal disease.
Vaccination reduces rates of death from invasive pneumococcal disease. At least half of these deaths are preventable with vaccination.
Pneumovax reduces duration of hospitalization for CAP. (see reference)
Pneumovax reduces rates of death from myocardial infarction and strokes as shown in a recent prospective trial (see reference)
The goal of pneumovax is to reduce death from invasive pneumococcal disease NOT to reduce the number of pneumonia cases.
The current national average for patients 65 years of age and over is 65% coverage. This is too low.
To address the issue of why only one dose after the age of 65 please see the attached algorithm that I put together. I hope that it better explains who needs to be vaccinated and how often. The recommendations are that EVERYONE get one dose of pneumovax after the age of 65. Anyone with additional risk factors will get the greater interval of vaccination per the higher risk group.
Chart showing who gets 23-valent pneumovax
Fisman, David N, Elias Abrutyn, Kimberly A Spaude, Alex Kim, Cheryl Kirchner, and Jennifer Daley. 2006. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 42, no. 8 (April): 1093-101. doi:10.1086/501354. http://www.ncbi.nlm.nih.gov/pubmed/16575726.
Hung, Ivan F N, Angela Y M Leung, Daniel W S Chu, Doris Leung, Terence Cheung, Chi-Kuen Chan, Cindy L K Lam, et al. 2010. Prevention of acute myocardial infarction and stroke among elderly persons by dual pneumococcal and influenza vaccination: a prospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 51, no. 9 (November): 1007-16. doi:10.1086/656587. http://www.ncbi.nlm.nih.gov/pubmed/20887208.
Dominguez, Angela, Lluis Salleras, David S Fedson, Conchita Izquierdo, Laura Ruiz, Pilar Ciruela, Asuncion Fenoll, and Julio Casal. 2005. Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 40, no. 9 (May): 1250-7. doi:10.1086/429236. http://www.ncbi.nlm.nih.gov/pubmed/15825026.
Vila-Córcoles, Angel, Olga Ochoa-Gondar, Imma Hospital, Xabier Ansa, Angels Vilanova, Teresa Rodríguez, and Carl Llor. 2006. Protective effects of the 23-valent pneumococcal polysaccharide vaccine in the elderly population: the EVAN-65 study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 43, no. 7 (October): 860-8. doi:10.1086/507340. http://www.ncbi.nlm.nih.gov/pubmed/16941367.
Johnstone, Jennie, Thomas J Marrie, Dean T Eurich, and Sumit R Majumdar. 2007. Effect of pneumococcal vaccination in hospitalized… [Arch Intern Med. 2007] – PubMed result. Archives of internal medicine 167, no. 18 (October): 1938-43. doi:10.1001/archinte.167.18.1938. http://www.ncbi.nlm.nih.gov/pubmed/17923592.
Jackson, Lisa a, and Edward N Janoff. 2008. Pneumococcal vaccination of elderly adults: new paradigms for protection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 47, no. 10 (November): 1328-38. doi:10.1086/592691. http://www.ncbi.nlm.nih.gov/pubmed/18844484.