# Pneumococcal vaccine **URL:** \ **Category:** Factual Questions\ **Created:** [January 12, 2013, 9:46pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995 "2013-01-12T21:46:58Z")\ **Posts on this page:** 13\ **Page:** 1
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 12, 2013, 9:46pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/1 "2013-01-12T21:46:58Z")
According to [Wiki](http://en.wikipedia.org/wiki/Pneumococcal_vaccine#Vaccination_in_the_USA): > [@](#): > > [G]enerally the vaccine should be a single lifetime dose, as there is a high risk of side effects if repeated. But the pharmacist who inoculated me today said that I would need a booster when I’m 65. Was she wrong? ---
**Author:** ![crowmanyclouds](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crowmanyclouds/32/19884_2.png) [@crowmanyclouds](https://boards.straightdope.com/u/crowmanyclouds)\ **Post date:** [January 12, 2013, 10:03pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/2 "2013-01-12T22:03:45Z")
IIRC Our PCP said every 5 (or was it 10) years for my mom who’s over 65. Now, she does emphysema and has had multiple congestive heart failure events, so maybe HMDV! CMC ---
**Author:** ![Lynn\_Bodoni](https://avatars.discourse-cdn.com/v4/letter/l/e47c2d/32.png) [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)\ **Post date:** [January 12, 2013, 10:05pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/3 "2013-01-12T22:05:07Z")
I was told, about six weeks ago, that I’m going to need a booster every 5 years. He was an ER doc, treating me for…pneumonia. I complained that I’d had my shot. So, at least one doctor says that you’re supposed to get one every five years. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 12, 2013, 10:15pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/4 "2013-01-12T22:15:08Z")
Hm. Maybe it’s one shot until you’re 65, and then every five years after that? Incidentally, I had spinal meningitis as an infant. I wonder if that afforded me any protection? ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [January 12, 2013, 10:22pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/5 "2013-01-12T22:22:57Z")
Pharmacist [correct](http://www.adultvaccination.org/professional-resources/pneumo-toolkit/adult-pneumo-guide-hcp.pdf). (Assuming it was the 23 valent one.) > [@](#): > > PPSV23 Revaccination: Those who received one dose of PPSV23 before age 65 years for any indication should receive another dose at age 65 years, or later, if at least five years has elapsed. [Here’s](http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwr-adult-schedule.pdf) the complete adult immunization schedule. I’m not an adult doc but I don’t see anything there about every five years. ---
**Author:** ![Nametag](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nametag/32/406_2.png) [@Nametag](https://boards.straightdope.com/u/Nametag)\ **Post date:** [January 12, 2013, 11:28pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/6 "2013-01-12T23:28:27Z")
According to the CDC’s PPSV information sheet: > [@](#): > > Usually only one dose of PPSV is needed, but under some circumstances a second dose may be given. > • A second dose is recommended for people 65 years and older who got their first dose when they were younger than 65 and it has been 5 or more years since the first dose. > • A second dose is recommended for people 2 through 64 years of age who: > > - have a damaged spleen or no spleen - have sickle-cell disease - have HIV infection or AIDS - have cancer, leukemia, lymphoma, multiple > myeloma - have nephrotic syndrome - have had an organ or bone marrow transplant - are taking medication that lowers immunity > (such as chemotherapy or long-term steroids) > When a second dose is given, it should be given 5 years after the first dose. The cite given for the statement that the polysaccharide vaccine needs to be re-administered after five years is [this paper](http://www.sph.unc.edu/images/stories/academic_programs/epid/documents/Qualifying_Exams/Infectious_Disease/Readings/pletz_int_j_antimicrobial_agents_2008.pdf) (PDF) by Mathias Pletz of the Hanover Medical School. From the above documents, I gather that the individual immunity conferred by PPSV23 lasts only 5-6 years, but that there are enough people with active immunity at any given time that the incidence of infection is tolerably low. Thus, the side effects and negative reactions are sufficient reason to recommend against routine boosters, even though the individual is no longer immune. ---
**Author:** ![Pai325](https://avatars.discourse-cdn.com/v4/letter/p/c68b51/32.png) [@Pai325](https://boards.straightdope.com/u/Pai325)\ **Post date:** [January 13, 2013, 12:30am UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/7 "2013-01-13T00:30:55Z")
I had one in the late seventies or early eighties, and my doctor told me it was a lifetime shot. Then about ten years later he told me it had changed to every ten years. Then my next doctor told me it had changed to every five years, where I think it still is now. I think I’ve had five or six of them but I’ve never had a problem with the shot. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 13, 2013, 3:26pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/8 "2013-01-13T15:26:04Z")
Note: The vaccine hurt going in. Not a sharp pain like burning as you get with some injections; more like that dull ‘heaviness’ you get in your bowels when you have diarrhea. But it went away soon. This morning if feels as if I’d been socked in the arm by someone wearing a large ring. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [January 14, 2013, 12:36am UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/9 "2013-01-14T00:36:06Z")
> [@Johnny\_L.A](#): > > Incidentally, I had spinal meningitis as an infant. I wonder if that afforded me any protection? Probably not. The bacteria causing meningitis in little kids are (usually) different from those causing it in adults. In particular, meningitis occurring in very young kids (less than a few months) is mostly due to what’s called [Group B Streptococci](http://en.wikipedia.org/wiki/Group_B_streptococcus) and [bacteria of the gram negative class](http://en.wikipedia.org/wiki/Gram-negative_bacteria). Older kids’ meningitis used to be caused by Haemophilus Influenzae but that’s fallen off as a cause since the advent of the Haemophilus vaccine. Bottom line is that older kids and adults meningitis is most often due to Strept pneumoniae and Neisseria meningococcus. So, you can see that if your meningitis was as a very young infant, the bug that probably caused it is irrelevant for an adult. And, even you were older when it happened, meaning that the same bug that caused yours is still a risk for meningitis in adults, previous exposure to bacteria, unlike the case for viruses, does not confer immunity\*. [\*You may ask, then, how vaccines against bacteria (e.g. against Haemophilus as above) ever work - I am no expert but I think the main idea is that the vaccine is comprised of a whole bunch of variants of the same type of bacteria. Presumably, you develop immunity by being exposed to a fuller spectrum of that bacteria - you develop antibodies and an immune response against each variant. So the vaccine is only as good as the diversity and completeness of the bacteria included in it.] ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [January 14, 2013, 3:38am UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/10 "2013-01-14T03:38:26Z")
Actually Karl the [top three](http://www.cdc.gov/meningitis/bacterial.html) [in infants and children](http://cmr.asm.org/content/23/3/467.full) are Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b. H. flu was the biggest one in years past but now it is probably close between the other two (the same two as adults) with Pneumococcus dropping fast (PCV13 is a damn good vaccine). > [@](#): > > The most common causative bacteria of community-acquired bacterial meningitis in children aged 3 months and older are S. pneumoniae and N. meningitidis, causing 80% of cases in the United States (110, 233, 248, 270). The remainder of cases are caused by group B streptococcus, Escherichia coli, nontypeable H. influenzae, other Gram-negative bacilli, L. monocytogenes, and group A streptococci (233) … The most common causative bacteria of community-acquired bacterial meningitis in adults are S. pneumoniae and N. meningitidis, causing 75 to 90% of cases (95, 286, 319). Of course you are correct about infants, under 3 month, having a different set of bugs. > [@](#): > > Common causative microorganisms of neonatal meningitis during the first week of life are S. agalactiae, Escherichia coli, and L. monocytogenes (6, 140, 152, 205, 222); L. monocytogenes has been reported to be spread by nursery personnel (75, 167). Late-onset neonatal meningitis occurs between the first week of life and 2 to 3 months of age and may be caused by a wide variety of species, including staphylococci, L. monocytogenes, and Gram-negative bacilli (140, 205, 259) ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [January 14, 2013, 5:19am UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/11 "2013-01-14T05:19:43Z")
> [@Johnny\_L.A](#): > > Note: The vaccine hurt going in. Not a sharp pain like burning as you get with some injections; more like that dull ‘heaviness’ you get in your bowels when you have diarrhea… A good and evocative description–I can’t comment as to its veracity, but I appreciate its specificity. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 14, 2013, 4:28pm UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/12 "2013-01-14T16:28:06Z")
It’s the closest thing I could think of. Sort of a feeling of ‘There’s something there that shouldn’t be there, and it wants out.’ As for the ‘socked in the arm’ feeling I had yesterday (and still have a bit today), that may or may not have been the pneumococcal vaccine. I did some reading later, and this sort of thing is commen with flu shots as well. I guess it’s a sign that my immune system is on the attack, and that the vaccine is doing its job. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [January 15, 2013, 6:24am UTC](https://boards.straightdope.com/t/pneumococcal-vaccine/646995/13 "2013-01-15T06:24:01Z")
Finally, a question entirely in my bailiwick. The recommendations for adult pneumococcal vaccination are often worded in a confusing way but here is what the CDC recommends: -Everybody should receive one dose of the pneumococcal vaccine at age 65. -Since response to vaccination tends to drop after the age of 65, routine revaccination is not recommended. -Anybody at high risk for pneumonia (those with chronic lung disease, asthma, heart disease, diabetes, or immune suppression or chronic smokers) should receive a dose as soon as possible after their diagnosis. -If this initial dose is given before the age of 65, a second dose should be given at 65 or in 5 years, whichever is later. -For those at extremely high risk (those without a spleen, immunosuppressed) the booster should be given at five years, regardless of the age (and ideally, the first dose is given before the spleen is removed). -There is no recommendation for routine boosters after the first although for those at very high risk many doctors will continue to give boosters every 5 years despite the lack of data (I will admit that I do this for my lung transplant patients at the recommendation of the transplant team). So, for an example: Healthy person with no high-risk diseases: one dose at 65 then done. Person with chronic lung disease: one dose when diagnosed, then another at 65 then done (except if first dose given between 60 and 65, then second dose after 5 years). Immunosuppressed patient: one dose when diagnosed, second dose in 5 years. Now where I practice many doctors and pharmacists recommend a dose every 5 years. While I could be cynical and claim that they are just out to make money, the truth is that the vaccine costs me $57 a dose and Medicare currently reimburses me $47 for the dose, plus $15 for administration. Once I pay staff costs, needles, and syringes etc I am lucky to break even. Therefore I will assume that they are simply unacquainted with the latest recommendations. It really does bother me, though, having to explain to a patient why they don’t need a pneumonia vaccine wih every flu vaccine since that is what their prior doctor did.