Pneumonia vaccines for adults (Pneumovax and Prevnar 13)

What is this bacteria that we are discussing, and what are its clinical manifestations in adults?

Streptococcus pneumoniae is a bacteria that can cause a wide range of infections, almost in all the organs of the body.
Pneumonia, which can occur at all ages, but is especially common in infants and the elderly, is one of the many different infections it can cause (from simple ear infections to meningitis and more).
Despite significant medical advances that have occurred in the past one hundred years in the medical world, mortality rates due to pneumonia in adults remain high.
Therefore, my friends, the best way to tackle this infection is to prevent it from happening in the first place with the help of vaccines.

What type of pneumococcal vaccines are available and how do they differ?

Most western countries in the world offer two main vaccines for pneumococcus (see the image below):
Pneumovax – an old vaccine made up of a polysaccharide that covers 23 different strains of the bacteria.
Prevnar 13 – a conjugate vaccine that is a relatively new vaccine, and covers 13 strains.
The Prevnar 13 vaccine conjugate technology allows for it to be effective in children under the age of two and therefore this vaccine is part of most national vaccine programs around the world. This vaccine is able to establish a strong immune reaction and provide better long-term immunological memory.
This brings us to the dose of Prevnar 13 that adults can receive once during their adulthood. More about this to follow below.
Hypothetically speaking, it seems like there is a huge advantage to the Pneumovax vaccine that covers 23 strains as opposed to Prevnar 13. Nonetheless, I must say, that the more important and dangerous strains are covered well by both vaccines. And there is also another vaccine that is currently under development; Prevnar 20, which covers 20 strains.

What are the adverse effects of these two vaccines?

Slight tenderness at the site of injection.
Both vaccines can be administered safely together with other vaccines, including COVID-19 and annual influenza vaccines (read more here).

Who is eligible for the pneumonia vaccines?

This gets a little complicated and may get confusing. I will discuss the eligibility rules that apply to most countries in the world. Refer to your national guidelines for more information.
The first group of people eligible for the pneumococcal vaccines are those who are at very high risk of developing bacterial infections. These include adults with anatomic or functional abnormality of the spleen, those who have undergone splenectomy, adults who have malignant diseases, are on immunosuppressive medication, are infected with HIV or AIDS patients, have undergone bone marrow transplantation or organ transplants, suffer from nephrotic syndrome, renal insufficiency or are on dialysis, those with cochlear transplants and people with cerebrospinal fluid leaks.
The other group of people who are eligible for it are those who are at increased risk of developing bacterial infection. These include adults with chronic illnesses such as diabetes, metabolic diseases, cardiovascular disease, chronic lung diseases, cirrhosis of the liver, alcoholism and also anyone over the age of 65 years, especially those living in institutions.

What about receiving both vaccines? Who do I think needs to get them both?

If the two vaccines complement one another, then provided there are no financial restrictions, there is no reason for someone to receive one without the other. They should both be part of the routine adult immunization program and in my opinion, they should be administered as early as age 60 for healthy adults. Note, however, that in order to make use of their full potential they need to be administered in the right order.

What is the correct schedule for pneumococcal vaccines in adults?

If an adult has never received either of these two vaccines, then the correct order would be to first receive Prevnar 13, and then receive Pneumovax 2 months later.
If an adult has already received one of the two vaccines in the past, then he can get the other anytime. But be aware of the comment below.

How many pneumococcal vaccines does an adult need to receive?

It is complicated and depends on the person’s status and their underlying conditions.
Very high-risk individuals receive Prevnar once during their adulthood.
As for Pneumovax – if an individual received their first dose before the age of 65, they need to receive the second and last dose 5 years after the first one. If an individual received Pneumovax after the age of 65, then there is no need for an additional dose.
If an individual has already received the Pneumovax vaccine, they can just go ahead and get vaccinated for Prevnar anytime.
If you have any more specific questions, especially if you are an individual who is at high risk of infection, consult with your primary care physician.

How can an adult receive these vaccines?

Refer to your primary care physician to find out whether or not you are eligible for the vaccine in your home country and how you can go about receiving it.

To summarize, these vaccines are a good opportunity for healthy people to prevent themselves from an unpleasant infection. And it is also an opportunity for mature individuals to try to protect their grandparents by getting them vaccinated.