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Thursday, October 6, 2011

WHEN TO GET A PNEUMONIA VACCINE


THE VIEW FROM THE OFFICE
(FIRST SNOW: OCTOBER 6TH, 2011)

WHO SHOULD GET A PNEUMONIA SHOT (PNEUMOCOCCAL VACCINE) AND WHEN? This is just a brief note to clarify this question. There are separate recommendations for children and adults.
     For children, the recommendations are to do primary immunizations at 2 months, 4 months, 6 months, and a booster immunization any time between 12 and 18 months. This immunization in children is clearly and highly effective. It has dramatically reduced the rates of meningitis, pneumonia, infected arthritis, and high fever in children without an obvious source. This vaccine and the H Flu vaccine are the primary reasons why we almost never see meningitis any more. This is the standard recommendation for healthy children.
     For older children the guideline calls for performing a primary vaccine series in any individual who has any kind of immune deficiency or chronic cardiorespiratory condition (like cystic fibrosis or congenital heart disease); for adults under the age of 65 a single dose of the vaccine is recommended for persons with a chronic cardiorespiratory or immune condition with a single booster shot 5 years after the first
     One example of a chronic immune condition is someone who has been in a bad accident and ruptured his/her spleen with the result that it has to be surgically removed. The spleen is a major organ of the immune system which protects against severe bacterial infections. So that anyone who has had their spleen removed for any reason should get a primary series of pneumococcal immunizations; they should also receive immunizations against the H Flu germ and the meningococcal germ. Also any individual who has a chronic cardiac or respiratory condition should receive the pneumococcal vaccine because the occurrence of pneumonia with a weakened lungs or heart could be fatal.

     For young and older adults under the age of 65 pneumococcal vaccine, in a single dose, is recommended for patients with cardiorespiratory conditions. These include: asthma, smoking, emphysema, and any form of heart disease.

     For ADULTS, the recommendation is simpler. All healthy adults should receive a pneumococcal vaccine at age 65. If you receive it at age 65 and are otherwise healthy, you only need to receive this single vaccine. You do not need a booster. For some reason that I cannot readily explain, a majority of older people in the Portola-Graeagle area believe they need routine pneumonia boosters every 5 years. This is NOT the case.

     There are two groups of adults who need pneumococcal boosters after age 65:
     (1) Any healthy adult who received their initial pneumonia shot before the age of 65 is recommended to get just one booster 5 years after the first.
     (2) Any adult who has a chronic immune system problem (examples include patients on long term systemic cortisone medications, on dialysis from chronic kidney failure, or who have received any organ transplantation, or who have cancer receiving chemotherapy, or who have HIV infection, or who have had their spleen removed) need to get a single booster 5 years after the first. The experts do not recommend repeated pneumococcal boosters for anyone.

SUMMARY:  Pneumococcal vaccine is recommended for:
     1. Healthy children at 2, 4, 6, and 12-18 months.
     2. Any older children with chronic immune or cardiorespiratory problems.
     3. For all adults under 65 who have a chronic  immune or cardiorespiratory problem.
     4. For all healthy adults at age 65.
     5. A single booster shot is recommended 5 years after the first immunization for:
         a. Healthy adults who received their pneumonia shot before the age of 65.
         b. For all adults who have a chronic cardiorespiratory or immune condition.

   

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