Kevin, M.D - Medical Weblog
Monday, October 18, 20041

Can't find the flushot? Get the pneumonia vaccine

With the influenza vaccine shortage, it is now being urged that seniors at least get the pneumonia vaccine - which is not in short supply:
The flu-shot shortage makes it more imperative for elderly Americans to get a second, often overlooked vaccine that protects against a type of pneumonia germ that’s a common complication of influenza.

Called pneumococcal vaccine, it’s a one-time shot for anyone 65 or older. Younger people with heart and lung diseases, diabetes or weak immune systems need it, too.
Bacterial pneumonia is a serious complication of influenza - and the bug that the vaccine protects against (Streptococcus pneumoniae) accounts for almost 50 percent of these cases. Here is a list of who should receive the pneumonia vaccine:
* Everyone 65 and older.
* Anyone with diabetes, heart disease, chronic lung disease except asthma, chronic liver disease or kidney failure.
* Anyone with weakened immune systems from cancer, HIV or organ transplants.
* People without a functioning spleen or who have sickle cell disease.
* Residents of long-term care facilities.
Medicare covers the cost the vaccine. For younger patients, cost ranges from $30 to $50.

Comments

  1. Anonymous Anonymous  

    Kevin:

    Randomized trials and meta-analyses have shown a benefit to pneumococcal immunization in young people with a high risk of pneumonia (e.g. SA gold miners, New Guinea highlanders, who have intact immune response, respiratory irritants, and close living quarters). The randomized trial (or meta-analysis) data supporting the immunization of the elderly is much more scant, despite the data from retrospective trials. There doesn't seem to be an effect on death or pneumonia, although there does seem to be some protection from bacteremia.
    http://www.biomedcentral.com/1471-2296/1/1
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14583920

    I like your idea, but I think you're overemphasizing the efficacy of pneumococcal vaccination. On the other hand, it is not unreasonable to approach pneumococcal immunization like Pascal's wager, and to advise it since it *may* help, and is unlikely to cause problems.

    Over on the CDC website, they show efficacy figures for Symmetrel and Tamiflu that approach those of influenza immunization (70%). This may be a more effective approach for those who cannot be immunized.

    12:39 PM

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