Influenza And Pneumococcal Immunization
Everyone plays a role in infection preventionpatients, families, and healthcare personnelin and out of healthcare facilities.
So do your part! Wherever you are, there is something you can do to stay safe from infections.
Two things that you can do for yourself and your loved ones are to receive an influenza vaccine annually and a pneumonia immunization at the appropriate time according to your age and health history. By doing so, you not only protect yourself, but you protect others who are vulnerable to severe illness or even death if they get one of these viruses.
Flu activity usually peaks in the U.S. in January or February. However, seasonal flu activity can begin as early as October and continue to occur as late as May. Flu is a contagious respiratory illness caused by influenza virus. It can cause mild to severe illness, and at times can lead to death. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications. Even healthy people can get sick enough to miss work or school for a significant amount of time or even be hospitalized. Learn the flu basics.
Which Influenza Vaccination Is Best For Older Adults
Looking at the list of available flu shots can be overwhelming. In looking at this years CDC table of available influenza vaccines, I counted eight options that are available for people aged 65 or older:
- 4 standard-dose quadrivalent inactivated vaccines
- 1 standard-dose quadrivalent inactivated vaccine manufactured with a newer cell culture-based technology
- 1 high-dose quadrivalent inactivated vaccine
- 1 standard-dose quadrivalent adjuvanted inactivated vaccine
- 1 quadrivalent recombinant vaccine
Only Fluzone High-Dose Quadrivalent and Fluad Quadrivalent carry an age indication specific to 65 years or older.
However, the CDC does not recommend any influenza vaccine over another, for adults aged 65 or older.
So if you are an older adult, or if youre trying to arrange a flu shot for an aging relative, which flu vaccine should you try to get?
My take is this: if you have a choice, go for one of the vaccines designed for older adults.
Why? Because we know that as people get older, their immune systems tend to respond less vigorously to immunization. And because research suggests that the high-dose flu shot generates higher antibody titers and has been associated with better influenza outcomes.
We do have more research and experience for Fluzone High-Dose than for Fluad, so unless you are enrolling in a clinical trial of Fluad, I would suggest going with the Fluzone High-Dose.
Children At High Risk Of Ipd
Infants at high risk of IPD due to an underlying medical condition should receive Pneu-C-13 vaccine in a 4 dose schedule at 2 months, 4 months and 6 months followed by a dose at 12 to 15 months of age. Table 3 summarizes the recommended schedules for Pneu-C-13 vaccine for infants and children at high risk of IPD due to an underlying medical condition by pneumococcal conjugate vaccination history.
In addition to Pneu-C-13 vaccine, children at high risk of IPD due to an underlying medical condition should receive 1 dose of Pneu-P-23 vaccine at 24 months of age, at least 8 weeks after Pneu-C-13 vaccine. If an older child or adolescent at high risk of IPD due to an underlying medical condition has not previously received Pneu-P-23 vaccine, 1 dose of Pneu-P-23 vaccine should be administered, at least 8 weeks after Pneu-C-13 vaccine. Children and adolescents at highest risk of IPD should receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization. Refer to Immunocompromised persons for information about immunization of HSCT recipients.
Table 3: Recommended Schedules for Pneu-C-13 Vaccine for Children 2 months to less than 18 years of age, by Pneumococcal Conjugate Vaccination History
|Age at presentation for immunization||Number of doses of Pneu-C-7, Pneu-C-10 or Pneu-C-13 previously received|
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What Are The Pros And Cons Of Being Vaccinated
The benefits of vaccination generally far outweigh any risks, Privor-Dumm says. Although vaccines do have some side effects, most are mild and temporary.
The bigger con is getting disease, which may lead to further health complications, she adds. For instance, people who are hospitalized with influenza have a greater likelihood of heart attack or stroke following their illness, and the economic consequences of a serious illness can be catastrophic for some. Thats why its best to prevent disease in the first place.
Everything You Need To Know About The Pneumonia Vaccine
During the winter months, many people think that they have a nasty cold or flu, but it turns out to be pneumonia an illness that can be life threatening in certain people. A vaccine can help lower your chance of contracting pneumonia. While the pneumonia vaccine does not prevent all cases of pneumonia, it reduces the severity of the disease.
That is especially important for older adults and if you have certain medical conditions that put you at greater risk for complications.
Now is the time to talk to your doctor about your risks and if you need a vaccine to protect you against pneumonia.
Niharika Juwarkar, MD, Internal Medicine with Firelands Physician Group, answers your most frequently asked questions about pneumonia and the risks.
What is pneumonia?
Pneumonia is a respiratory lung infection that is often mistaken for the flu. Your lungs become filled with fluid or pus that results in inflammation. Symptoms are very similar to the flu, but pneumonia can last for weeks and result in very serious complications.
While pneumonia can be caused by bacteria, viruses or fungi, most cases are due to a specific bacteria called streptococcus pneumoniae, more commonly known as pneumococcal pneumonia. This form can be treated with antibiotics. Your doctor can test to see what form of pneumonia you have. Treatment depends on the type of pneumonia you have and the severity of your symptoms. But, the best defense is vaccination.
Who is most at risk for pneumonia?
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Prevnar 20 Coadministered With Flu Vaccine Immunogenic Safe In Older Adults
Positive topline results were announced from a phase 3 study evaluating the safety and immunogenicity of Prevnar 20 administered with the seasonal influenza vaccine in adults 65 years of age and older.
The randomized, double-blind trial enrolled a total of 1796 participants, of which 1727 completed the study. Participants were randomly assigned to receive either the Prevnar 20 and seasonal influenza vaccine at the same visit followed by a saline injection 1 month later or saline injection and seasonal influenza vaccine at the same visit followed by Prevnar 20 one month later.
Findings demonstrated that the administration of Prevnar 20 with seasonal influenza vaccine elicited responses that were noninferior to those observed when the vaccines were administered 1 month apart. Moreover, the safety profile of Prevnar 20 was found to be similar when the vaccines were administered together compared with when the vaccines were administered 1 month apart.
We are encouraged by these results showing that these 2 vaccines can be administered at the same time without affecting the immune protection provided by either vaccine or changing the safety profile, said Kathrin U. Jansen, PhD, Senior Vice President and Head of Vaccine Research & Development, Pfizer. This study adds to the body of evidence further supporting that pneumococcal conjugate vaccines may be coadministered with influenza vaccines, this time studied with the adjuvanted influenza vaccine.
Where Can I Find These Vaccines
Your doctors office is usually the best place to receive recommended vaccines for you or your child.
PCV13 is part of the routine childhood immunization schedule. Therefore, it is regularly available for children at:
- Pediatric and family practice offices
- Community health clinics
If your doctor does not have pneumococcal vaccines for adults, ask for a referral.
Pneumococcal vaccines may also be available for adults at:
- Health departments
- Other community locations, such as schools and religious centers
Federally funded health centers can also provide services if you do not have a regular source of health care. Locate one near youexternal icon. You can also contact your state health department to learn more about where to get pneumococcal vaccines in your community.
When receiving any vaccine, ask the provider to record the vaccine in the state or local registry, if available. This helps doctors at future encounters know what vaccines you or your child have already received.
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Adults At High Risk Of Ipd
Adults with immunocompromising conditions resulting in high risk of IPD, except HSCT, should receive 1 dose of Pneu-C-13 vaccine followed at least 8 weeks later by 1 dose of Pneu-P-23 vaccine, if not previously received. The dose of Pneu-C-13 vaccine should be administered at least 1 year after any previous dose of Pneu-P-23 vaccine. Refer to Immunocompromised persons for information about immunization of HSCT recipients.
Immunocompetent adults with conditions or lifestyle factors resulting in high risk of IPD should receive 1 dose of Pneu-P-23 vaccine, if not previously received. One dose of Pneu-P-23 vaccine is also recommended for all adults who are residents of long-term care facilities and should be considered for individuals who use illicit drugs.
Some experts also suggest a dose of Pneu-C-13 vaccine, followed by Pneu-P-23 vaccine, for immunocompetent adults with conditions resulting in high risk of IPD as this may theoretically improve antibody response and immunologic memory. However, Pneu-P-23 vaccine is the vaccine of choice for these individuals, and if only one vaccine can be provided, it should be Pneu-P-23 vaccine, because of the greater number of serotypes included in the vaccine.
Adults at highest risk of IPD should also receive 1 booster dose of Pneu-P-23 vaccine refer to Booster doses and re-immunization.
Table 4 – provides recommended schedules for adult immunization with pneumococcal vaccines.
When Should You Schedule Your Vaccines
Older adults should get their flu shots by the end of October or ideally even sooner, particularly in light of the expected increase in demand for the 202021 winter season caused by the COVID-19 pandemic.
In fact, given the concerns surrounding the pandemic, older adults should make sure they are up to date on all their vaccinations and any booster shots by the end of October, before winter sets in, Privor-Dumm says.
Still, its important to stagger your vaccinations, as getting them all done at one time could lead to complications. Talk to your doctor about setting up a vaccination schedule that works for you.
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Effectiveness Of The Pneumococcal Vaccine
Children respond very well to the pneumococcal vaccine.
The introduction of this vaccine into the NHS childhood vaccination schedule has resulted in a large reduction in pneumococcal disease.
The pneumococcal vaccine given to older children and adults is thought to be around 50 to 70% effective at preventing pneumococcal disease.
Both types of pneumococcal vaccine are inactivated or “killed” vaccines and do not contain any live organisms. They cannot cause the infections they protect against.
Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional information about vaccination of people with chronic diseases.
Asplenia or hyposplenia
Hyposplenic or asplenic individuals should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine, followed by a booster dose of Pneu-P-23 vaccine. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic kidney disease and patients on dialysis
Individuals with chronic kidney disease should receive age appropriate pneumococcal vaccines. Children less than 18 years of age with chronic kidney failure or nephrotic syndrome, should receive Pneu-C-13 vaccine and Pneu-P-23 vaccine. Adults with chronic kidney failure should receive Pneu-P-23 vaccine. Adults with nephrotic syndrome should receive Pneu-C-13 and Pneu-P-23 vaccine. Due to the decreased immunogenicity and efficacy of Pneu-P-23 vaccine in children and adults with chronic kidney failure, 1 booster dose of Pneu-P-23 vaccine is recommended. Refer to Table 3, Table 4 and Booster doses and re-immunization for additional information.
Chronic lung disease, including asthma
Chronic heart disease
Chronic liver disease
Endocrine and metabolic diseases
Non-malignant hematologic disorders
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Influenza Vaccination For Pregnant Women
- Women who are or will be pregnant during influenza season should receive inactivated influenza vaccine . Live attenuated influenza vaccine is not recommended for use during pregnancy.
- Postpartum women can receive either LAIV or IIV.
- Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.
What You Need To Know About Pneumonia And Flu Shots
This article was first published in The Montreal Gazette.
Recently, Oprah got pneumonia. Then she went on Ellen to recommend that everyone get their flu and pneumonia shots. Given that only 42 per cent of Canadians over the age of 65 got the pneumonia vaccine in 2016, maybe Oprah can get us over the 80 per cent target.
Sadly, Oprah has not always been a strong advocate for science. She gave a platform to Jenny McCarthy when she started claiming that vaccines caused her sons autism, and she also introduced the world to Dr. Oz.
But as Oprah explained to Ellen, pneumonia is no joke. Around 1.5 million people are hospitalized with pneumonia every year. Around 100,000 die in hospital and a third of people hospitalized with pneumonia die within the year.
Older patients are at greater risk and so are those with pre-existing lung disease. Smoking is also a risk factor for pneumonia, so if you need an extra incentive to stop smoking, this is it. But the main way to prevent pneumonia is with vaccines.
The problem with the pneumonia vaccine is not one of efficacy. A Cochrane meta-analysis of 18 randomized trials found that the pneumonia vaccine led to a substantial reduction in infections. The problem is which pneumonia vaccine to give people.
And if you wont listen to me, at least listen to Oprah.
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Conjugate Vaccine Carrier Proteins
Protein conjugates used in Hib conjugate vaccines produced in the United States include tetanus toxoid which is also used as a component of DTaP and Tdap vaccines . Simultaneous or sequential vaccination with Hib and these tetanus-toxoid containing vaccines is recommended when both are indicated . MCV4 and PCV13 both contain diphtheria-toxoid conjugates. There has been concern about simultaneous administration of vaccines containing like conjugates. One brand of MCV4, MenACWY-D , demonstrates reduced immunogenicity of the antibody response to Streptococcal pneumonia strains when administered simultaneously with PCV13 compared with separate administration. It is recommended to space these vaccines by 28 days in a person with anatomic asplenia . Simultaneous or sequential vaccination of MCV4-CRM , PCV13, and Tdap , all of which contain diphtheria toxoid, is not associated with reduced immunogenicity or increase in local adverse events.
Persons With Inadequate Immunization Records
Children and adults lacking adequate documentation of immunization should be considered unimmunized and should be started on an immunization schedule appropriate for their age and risk factors. Pneumococcal vaccines may be given, regardless of possible previous receipt of the vaccines, as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information about vaccination of people with inadequate immunization records.
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Unknown Or Uncertain Vaccination Status
Vaccination providers frequently encounter persons who do not have adequate documentation of vaccinations. With the exception of influenza vaccine and PPSV23, providers should only accept written, dated records as evidence of vaccination self-reported doses of influenza vaccine and PPSV23 are acceptable . The rationale for acceptance for influenza vaccine is that the time period of recall is one year or less, making it very likely that correct recall will occur. The rationale for acceptance for PPSV23 is high frequency of vaccination leads to an increased rate of local reactions due to the reactogenicity of this vaccine. Although vaccinations should not be postponed if records cannot be found, an attempt to locate missing records should be made by contacting previous health care providers, reviewing state or local IISs, and searching for a personally held record. If records cannot be located within a reasonable time, these persons should be considered susceptible and started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens . However, commercial serologic testing might not always be sufficiently sensitive or standardized for detection of vaccine-induced immunity , and research laboratory testing might not be readily available.
Based on expert opinion.
TABLE 3-1. Recommended and minimum ages and intervals between vaccine doses,,,
When To Get The Vaccine
Thereâs no such thing as pneumonia season, like flu season. If you and your doctor decide that you need to have a pneumonia vaccine, you can get it done at any time of the year. If itâs flu season, you can even get a pneumonia vaccine at the same time that you get a flu vaccine, as long as you receive each shot in a different arm.
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Who Should Get The Vaccine
People over age 65. As you age, your immune system doesnât work as well as it once did. Youâre more likely to have trouble fighting off a pneumonia infection. All adults over age 65 should get the vaccine.
Those with weakened immune systems. Many diseases can cause your immune system to weaken, so itâs less able to fight off bugs like pneumonia.
If you have heart disease, diabetes, emphysema, asthma, or COPD , youâre more likely to have a weakened immune system, which makes you more likely to get pneumonia.
The same goes for people who receive chemotherapy, people who have had organ transplants, and people with HIV or AIDS.
People who smoke. If youâve smoked for a long time, you could have damage to the small hairs that line the insides of your lungs and help filter out germs. When theyâre damaged, they arenât as good at stopping those bad germs.
Heavy drinkers. If you drink too much alcohol, you may have a weakened immune system. Your white blood cells donât work as well as they do for people with a healthy immune system.
People getting over surgery or a severe illness. If you were in the hospital ICU and needed help breathing with a ventilator, youâre at risk of getting pneumonia. The same is true if youâve just had major surgery or if youâre healing from a serious injury. When your immune system is weak because of illness or injury or because itâs helping you get better from surgery, you canât fight off germs as well as you normally can.