Preventive Medicine


I have long been confused by the recommendations for vaccinations against Pneumococcus.

Pneumococcal disease is caused by a bacteria called Streptococcus pneumoniae. Strep pneumonia, pneumococcal pneumonia, and pneumococcus are all different names for the same thing. This Streptococcus, however, is not the Strep that causes the common Strep throat—that is called Group A Beta-Hemolytic Streptococcus. It’s also not one of the more worrisome species of Strep such as pyogenes and viridans.

This Strep, also called Pneumococcus pneumoniae, has a characteristic appearance under the microscope that distinguishes it from all other Strep varieties and makes it easy to identify. The pneumococcus resides in the human respiratory tract and spreads by droplets in the air. Pneumococcal disease presents in many forms primarily involving the upper and lower respiratory tracts. Thus it causes:



Ear Infections



Bacteremia and meningitis are potentially fatal infections, especially in children, so vaccination against pneumococcal diseases is highly recommended. Pneumonia is the most prominent of the pneumococcal disease so this immunization has become known popularly as “the pneumonia vaccine.”

There are three types of “pneumonia vaccine.”

1. Prevnar 7–effective against 7 types of pneumococcus—NO LONGER IN USE

2. Prevnar 13–effective against 13 types of pneumococcus-used in children

3. PPSV 23 (Pneumovax)—effective against 23 types of pneumococcus-for adults over 18

Which age group gets which vaccine?

1. Age 65 and older: ONE DOSE OF PPSV 23 (PNEUMOVAX)—only

2. A booster vaccination is NOT Necessary

2.1. Patients with a “high-risk indication” for Prevnar 13 should have it first followed one

month later by Pneumovax.

3. Age 19-64, and you’ve not had Pneumovax: A single dose of PPSV 23 followed by a

second dose 5 years after the first, with a booster at age 65.

4. Prevnar 13 is NOT RECOMMENDED over age 64, but can be given.

5. Children: Prevnar 13 at 2, 4, 6, and 12-15 months of age.

6. At any age smokers should receive Pneumovax.

Until recently, Pneumovax was recommended every 5 years, and like a good little doctor I followed protocol. But the Advisory Committee on Immunization Practices (ACIP) changed that recommendation in 2014. Now a single dose is give at age 65.

PPSV 23 has been in use for a long time, and I have never heard of an adverse effect. When in practice I gave it nearly every day with very little concern of reaction. It is a vaccination I have had myself. I wholeheartedly recommend all adults, especially 65 and over, receive it at the time appropriate for their age group.

Reference: Https:// experts/experts_pneumococcal_vaccines


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