ASK DR. BAUGHAN                                             October 9, 1998

THE FORGOTTEN VACCINE

The influenza vaccine (flu shot) has the earmarks of becoming an autumn ritual along with leaf peepers and traffic.  In Carroll County as well as the rest of the country, we still have a long way to go in achieving the immunization rates we would like to see in order to avoid life-threatening cases of influenza in those most at risk.  It is my impression, though, that most everyone has heard about the flu vaccine and has an opinion one way or the other on whether they want to get the shot.  Last year’s column around this date dealt with some of the beliefs and myths about the flu vaccine that I have heard that persuade people not to get it.  I had hoped to be able to report that the flu vaccine could now be administered via a nasal spray, but that did not make it through the approval process for this season.  Maybe next year.

There is another vaccine that needs wider attention, though.  That is the pneumococcal vaccine, sometimes called the Pneumovax.  This vaccine protects against infections from the pneumococcal pneumoniae bacteria, more recently renamed streptococcal pneumoniae.   “Pneumococcus” can cause infections in multiple places in the body, including the skin and urinary tract, but as you might suspect, the most common infection is pneumonia, an infection of the lungs.  Many different bacteria and viruses can cause pneumonia, but pneumococcal pneumonia is still the most common type of pneumonia to cause hospitalization and death in the elderly.  If pneumococcus gets in the blood stream, it can cause a rapidly fatal illness, as it did in Jim Henson of Muppet fame several years ago.

The vaccine was first developed in the 1970s to be used in younger patients who were at risk for pneumococcal bacteremia (the blood stream infection), such as people who had their spleens removed due to trauma.  The blood stream infection would often progress so rapidly that antibiotics would not have time to work, so prevention through immunization became a more effective treatment.  Other patients with spleen problems, immune system problems, cancers, or kidney disease then were immunized, with good safety results and decrease in deaths.

As the problem of bacteria resistant to antibiotics increased in the 1980s and 90s, more attention shifted to prevention of pneumonia.  Before the advent of penicillin, even younger people used to die from pneumococcal pneumonia.  Most types of pneumococcus will still respond to antibiotics in younger, previously healthy patients, but those over 65 may not respond quickly enough, or they may have complications from the use of broader-spectrum antibiotics.

The vaccine is indicated for anyone over 65, and anyone with chronic disease, particularly chronic lung or heart disease.  We used to think that one vaccine lasted a life-time, but in the past few years the recommendation has changed to get a booster shot every 6-7 years.  It can be given any time of year, and can be given along with the flu vaccine.  It can help prevent ever getting pneumococcal pneumonia; it also can prevent recurrent pneumonia if given to someone recovering from pneumonia.  One study estimated that immunizing everyone who needs it would cost half as much as treating those who get hospitalized with this type of pneumonia.

The only side effects are a sore arm for a few days.  There were rarely other symptoms after the vaccine; about the same number of complaints people had the week before they had the vaccine.  One drawback is that the immune system of  older folks does not respond  to the vaccine as well as younger people who do not need it as much.  Twenty percent of the elderly may not develop antibodies to pneumococcus.  However, since at present only 30% of those who would benefit from the vaccine are getting it, there is still a lot of pneumonia that could be prevented if it were more widely used.