Pneumococcal Disease Vaccination: Recommendations for the Older Adult

August 10, 2017 Jeanette Stern

Pneumococcal disease, a serious infection with the strep pneumoniae bacteria, remains a leading cause of death and morbidity around the world. The infection strikes at those who cannot fight off a strong infection, and can lead to serious and potentially deadly disease such as meningitis, bacteremia and septic shock, and pneumonia. For the older adult, the CDC has recently revised guidelines for immunization using the two types of pneumococcal vaccines that are currently available in the US. 

While there are 90 known subtypes of strep pneumoniae bacteria, two immunizations cover the most dangerous and common types. The pneumococcal conjugate vaccine is known as PCV-13, and includes protection against strep pneumonia, of particular concern for older adults and those with weakened immune systems. The second pneumococcal vaccine is a polysaccharide vaccine, and it protects against 23 subtypes, including those that cause meningitis. This second vaccine is known as PPSV-23.

For adults over 65, the CDC recommends both types of pneumococcal vaccines. The revised recommendations this year are for adults over 65 to receive the PCV-13 first, and to receive the PPSV-23 a year later. This schedule is for those who have received no pneumococcal vaccines at all. 

The last few years has seen some changes in the recommendations, so many adults have had one or the other of the vaccines. To have full coverage, anyone who has not had PCV-13 should receive it, as it protects against pneumonia. For those who received PPSV-23 first, the recommendation is to wait for one year to receive the PCV-13. The hope is that by age 66, everyone will have received both the PCV-13 and the PPSV-23.

For those younger than 65, and those with serious or chronic health conditions, the guidelines become open to some interpretation by your health care provider. Many recommend a second dose of PPSV-23 five years after the first, as long as two doses are not given after 65. Scientists are researching vaccine response in the frail elder, those over 80, but at this time, recommendations are only given for one dose of each after 65.

Chronic health problems, such as COPD, asthma, diabetes, and heart disease, as well as conditions that predispose a young adult to immune dysfunction, such as the loss of the spleen, HIV disease with a low T-lymphocyte count, Hodgkin's lymphoma, and sickle cell disease, all suggest a need for protection against pneumococcal disease. Generally, the PCV-13 is given first, with the PPSV-23 following in a year. For some conditions, such as those receiving dialysis for renal failure, the doctor may recommend the PPSV-23 first.

For many viral conditions, the assumption is made that healthy adults have immunity, even if they have never received the immunization or had the disease. That is not the case with pneumococcal disease. Natural immunity is not enough to protect against this dangerous infection, even in those who successfully fought off the condition during a prior illness. With over 90 sub-types, the only known protection against the infections is the two vaccines. For an elder who contracts pneumococcal disease, the infection can be passed to family members with compromised health and immune systems. 

The recommendations are for the PCV-13 to be given at age 65, if the adult has not received it before. There are other vaccines that are recommended at the same time. It is safe to give PCV-13 or PPSV-23 along with other immunizations, including live virus vaccines such as MMR if needed. The CDC recommendations actually prefer the recommended vaccines at age 65 be given together.

Routine immunizations for all adults at 65 include an annual influenza, a shingles vaccine (herpes zoster) a tetanus-diptheria-pertussis booster is it has been longer than ten years since the last, and the pneumococcal, PCV-13, followed by PPSV-23 in a year. There are no live influenza immunizations recommended at this time. MMR, which is the live virus vaccine for measles, mumps, and rubella, is only needed for those who work in hospitals.

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