From respiratory syncytial virus (RSV) to whooping cough, respiratory infections that surge every winter cause severe coughs, fevers, and chills, and can also create the perfect opportunity for deadly pneumonia. Although often misunderstood as a single, ominous disease (the one your parents ominously warned you would catch if you forgot your jacket), pneumonia can actually be caused by any of about 30 different pathogens. Refers to a lung infection that is caused. It is one of the leading causes of death in people over 70 years old or under 5 years old. It can also be fatal for people with weakened immune systems or other medical conditions that put them at higher risk.
According to the Centers for Disease Control and Prevention, pneumonia was the primary diagnosis for more than 1.4 million patient visits to U.S. emergency rooms in 2021, and more than 40,000 people died from pneumonia in 2022. However, preventive vaccines against certain types of bacteria are pneumococcus, The risk of hospitalization and serious complications can be significantly reduced.
And this season, those vaccines are finally becoming available to more people. On October 23, CDC Director Mandy Cohen announced a set of expanded eligibility recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP), an independent expert group on vaccine-preventable diseases. I supported it. These guidelines lower the recommended age for receiving this pneumococcal pneumonia vaccine from 65 to 50, reaching millions of people who currently do not receive protection. scientific american We spoke to experts about pneumonia risks and how vaccination can help.
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What is pneumonia and how serious is it?
“Pneumonia” simply means “inflammation of the lungs” and can be caused by a variety of viruses, bacteria, and fungi. Symptoms include cough, fever, sharp chest pain, and difficulty breathing. Bacterial pneumonia is usually treatable with antibiotics, while viral pneumonia (caused by pathogens such as influenza and SARS-CoV-2, the virus that causes coronavirus) usually clears up on its own.if The body can fight them off.
But all types of pneumonia can be dangerous, especially for people over 85, who are four times more likely to get infected than people under 65. Death is especially common in older people with weakened immune systems or associated chronic conditions. Pneumonia is sometimes even called the “old man’s friend.” This is because people with other more painful illnesses often develop pneumonia and die relatively quickly and often painlessly. “It’s not a bad idea,” said Michael Rothberg, an internist at the Cleveland Clinic.
Before antibiotics were discovered, pneumococcus Whereas it used to cause 90 percent of all pneumonia cases, it now accounts for less than 10 to 15 percent.
“Walking pneumonia” is a mild but highly contagious form of the disease that is common in children and is usually caused by another bacteria called . mycoplasma pneumonia. Recently, more hospitals have reported a wave of pediatric cases, raising concerns about the issue.
Bacterial pneumonia can often be effectively treated with a short course of antibiotics. The main danger is that it can become “invasive”, spreading from the lungs into the bloodstream or into the brain and spinal cord. Invasive pneumonia causes approximately 3,000 deaths annually in the United States. “It would be great if we could lower that rate,” says ACIP member Jamie Lohr, a family physician in Ithaca, New York.
Who is currently eligible to receive the vaccine?
Since 2014, the CDC has recommended the pneumonia vaccine for everyone age 65 and older and those with chronic conditions such as diabetes, kidney disease, HIV, and infectious diseases who are at risk of complications from bacterial pneumonia. Pneumonia vaccines are also recommended for adults of all ages who are at increased risk. If you have a lung disease such as emphysema, or if your immune system is weakened for some reason.
These recommendations are generally effective among older populations. According to one study, the number of people 65 and older who received at least one dose of a pneumonia vaccine increased from 47 percent in 2014 to 63 percent in 2019. High-risk individuals between the ages of 19 and 64 were vaccinated in 2022. This is especially concerning for adults between the ages of 50 and 64. About half of Americans in this group have at least one medical condition that increases their risk of pneumococcal pneumonia. Experts say lowering the age range to age 50 could help protect many people in this group, including those who don’t know they have chronic conditions.
There are also practical considerations, says Sandra Freihofer, an internist in Atlanta. Since the coronavirus pandemic, “many patients are getting their vaccinations at pharmacies, but pharmacists don’t know the patients as well as doctors,” she says. The new guidelines will make it easier for pharmacists to recommend vaccines based on a person’s age, even if they don’t know the person’s medical history. “We will now be able to include patients who were missed,” Freihofer added.
Lowering the age of eligibility could also address health equity issues. Although the reasons are not entirely clear, black people have higher rates of pneumococcal pneumonia in their 50s at all ages than other races. “Just saying, ‘We’re all 50 years old,’ might narrow the gap,” Rothberg said.
What pneumonia vaccines are available and how do they work?
New ACIP guidelines recommend that people age 50 and older receive an injection called a pneumococcal conjugate vaccine (PCV) that contains one of the following: pneumococcus It attacks sugar molecules on the surface, prompting the immune system to recognize and attack the molecules. Vaccine developers attach this molecule to an inactivated toxin, stimulating a stronger immune response when it enters the body. The guidelines specify one of two combination vaccines. One, PCV20, protects people from 20 different viruses. pneumococcus It is responsible for more than 50% of invasive infections in adults. The other, PCV21, covers 21 types that cause more than 80% of adult infections (but does not cover types that are more frequent among people who are unhoused and in multiple geographical locations). (I have not done so).
Knowing which of these types to include in a new vaccine is always a challenge, Rothberg says. The United States has begun routinely vaccinating children. pneumococcus In 2000, it was successful in reducing the spread of the species targeted by its vaccine. This has reduced the number of adult infections caused by these types, but has also made other types of infections more common. More comprehensive vaccinations are currently in early clinical trials, with at least one company developing two vaccines, one covering 24 and one covering 31.
How effective are vaccines?
There is not much long-term data on the ability of PCV21 or PCV20 to prevent disease or how long their effects last. Clinical trials suggest it is about as effective as the older vaccine, PCV13, in boosting immune responses to bacteria. A study in the Netherlands found that PCV13 was about 46 percent effective in preventing pneumonia caused by the virus in adults 65 and older. pneumococcus 75% effective at typesitting targets and preventing infiltration of infection. All pneumonia vaccines are much more effective in children than in the elderly because the immune system weakens with age.
Rothberg says it’s unclear whether the vaccine will cause a stronger or longer-lasting response in a 50-year-old’s immune system than in a 65-year-old’s. ACIP will now decide whether to recommend booster shots for people who received a vaccine more than five years ago or who received an earlier version of the vaccine that covers fewer types, Rohr said.
