Pneumonia, Flu, and COVID-19
In our final installment, we explore updates to three vaccines essential to protecting older adults from common, contagious and potentially life-threatening conditions: pneumonia, influenza and COVID-19.
Pneumonia vaccine: a confusing path forward?
A bit of background: Two generations ago, pneumonia was a very common cause of death not only among the old and infirm, but also among the young and healthy. For example, my father-in-law was a young child when his father contracted pneumonia and died at age 46, leaving his widow to raise 9 children herself. Many different forms of pneumonia occur but the most aggressive and virulent one is bacterial pneumococcal pneumonia. There are multiple strains of the pneumococcal organism. Fortunately, over the last three decades, pneumococcal vaccines have been developed that prevented countless cases of pneumonia and saved many lives.
Current vaccines: For the last 15 years or so, we have used a three-shot series consisting of two shots of Pneumococcal 23 (PPSV23) five years apart and one dose of Prevnar 13. Recently two new vaccines – PCV20 and PCV15 – have essentially replaced Prevnar 13. They both represent improvements to Prevnar 13, are similar to each other, and either can be combined with Pneumococcal 23 shots. The result is two new vaccines, multiple abbreviations, and a less-than-clear path for deciding which vaccine is best to use. While this will be better defined over time, my current guidance is:
- If you have not yet received any pneumonia vaccines, using one of the new vaccines is recommended.
- If you are in the middle of the three-shot series, it is reasonable to simply complete the series.
- If you have already completed the three-shot series, you are amply protected, and nothing more is needed
Influenza vaccine: effectiveness can vary, but still an annual essential
A bit of background: Every June and July, U.S. medical experts explore influenza occurring in Australia, New Zealand, Taiwan, South Korea and Japan, and identify the four most worrisome strains (two of Influenza A and two of Influenza B) to incorporate in our seasonal flu shots. This process usually works well because the influenza viruses circumnavigate the world from west to east, and the experts’ predictions are generally reliable. Today, 70% of American adults get their annual influenza vaccine. For older adults, the High Dose Quadrivalent Vaccine with two strains of Influenza A and two strains of Influenza B, is recommended.
Current situation: Unfortunately, the expert predictions have not been as accurate this year, in my opinion. I have diagnosed more Influenza A this winter than in the last five years in total. While my clinical experience with my own patient population may be unique, I suspect that this pattern will be seen nationwide by the end of this flu season.
The future: Breakthroughs in influenza vaccines are very likely in the next few years, evolving either from current influenza vaccine technologies or the mRNA technology of COVID vaccines. The first major change will be development of a universal influenza vaccine to provide broader and longer-lasting immunity against all strains of influenza. This vaccine will likely be administered every 3 to 5 years and serve as base protection against all types of Influenza A and Influenza B strains. The annual flu shot will still be given, but can become more specific to a larger number of active variants in any particular year or season.
COVID-19 vaccines: a quick update
We have all heard so much about the remarkable, game-changing mRNA COVID-19 vaccines. I was not surprised with the rapid development of these vaccines because I was aware of the many years of vaccine research sitting unused in scientific laboratories, awaiting an opportunity for clinical utility. Currently about 70% of people are getting these vaccines.
A new vaccine called Novavax was authorized in October, 2022, which is manufactured differently from the mRNA vaccines. It’s made with a traditional virus-blocking technology that has been previously used in vaccines to prevent shingles, DTaP (diphtheria, tetanus, and pertussis), and other conditions. It appears to be effective and safe.
In case you missed it
Check out the first two posts in our series of Essential Vaccinations Every Adult Should Consider:
- Part One – Shingles
- Part Two – Diphtheria, Tetanus, and Pertussis
Determining the most appropriate vaccinations to protect your health is best done on an individual basis. As always, I encourage members of Larew Internal Medicine to call the office and discuss their vaccination schedule with us.