The respiratory bugs that rise in winter, from there respiratory syncytial virus (RSV) to coughThey hit us with nasty coughs, fevers and chills, and they can also create a perfect opportunity for deadly pneumonia. Often misunderstood as a single, insidious disease (the one your parents warned you’d catch if you forgot your coat), pneumonia actually describes a lung infection that can be caused by about 30 different pathogens. It is one of the leading causes of death in people over 70 or under 5 years of age. And it can be fatal for anyone with a compromised immune system or other disorders that put them at high risk.
Pneumonia was the leading diagnosis in more than 1.4 million visits to US emergency rooms in 2021, and more than 40,000 people died in 2022. According to the US Centers for Disease Control and Prevention. But preventive vaccines against a certain type of bacteria, Streptococcus pneumoniae it greatly reduces the risk of hospitalization and serious complications.
And this season, these vaccines are finally being made available to more people. On October 23, CDC Director Mandy Cohen approved a set expanded eligibility guidelines the agency’s Advisory Committee on Immunization Practices (ACIP)—an independent panel of experts on vaccine-preventable diseases. These guidelines reduce the recommended age for getting the pneumococcal pneumonia vaccine from 65 to 50, covering millions of people who are currently unprotected. American scientific spoke to experts about the dangers of pneumonia and how more vaccinations can help.
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What is pneumonia and how serious is it?
“Pneumonia” is simply the word for “inflammation of the lungs” and can be caused by various viruses, bacteria or fungi. Symptoms including cough, fever, sharp chest pains and difficulty breathing. Bacterial pneumonias are usually treated with antibiotics, while viral pneumonias (caused by pathogens such as the flu or the SARS-CoV-2 virus that causes COVID) generally go away on their own—if the body can resist them.
But any type of pneumonia can be dangerous, especially in people over 85, who are four times more likely to get it than people under 65. Deaths are especially common among the elderly with weakened immune systems or significant chronic conditions. It has also sometimes been called pneumonia”old friend”—because people with other more serious illnesses often get pneumonia and die relatively quickly, and in many cases, painlessly. “It’s not a bad way,” says Michael Rothberg, an internist at the Cleveland Clinic.
Before antibiotics were discovered, S. pneumoniae used to cause 90 percent of all pneumonia cases, but now accounts for less than 10 to 15 percent.
“Walking pneumonia“, a mild but highly contagious form often seen in children, is usually caused by another bacteria called Mycoplasma pneumoniae. Recently it has become a growing concern, with more hospitals reporting it a wave of cases in children.
Bacterial pneumonia can often be treated effectively with a short course of antibiotics. The main risk is that it can become “invasive”, spreading from the lungs to the bloodstream or to the brain and spinal cord. It causes invasive pneumonia approximately 3,000 deaths per year in the US. “Reducing that incidence would be fantastic,” says ACIP member Jamie Loehr, a family practice physician in Ithaca, NY.
Who is now eligible for vaccinations?
Since 2014, the CDC has recommended the pneumonia vaccine for everyone age 65 and older, as well as adults who are at increased risk for complications from bacterial pneumonia because they have diabetes, kidney disease, HIV, or a chronic medical condition. lung diseases such as emphysema or are immunocompromised for any reason.
These recommendations have generally been effective among older people: one study found an increase in the number of people 65 and older who received at least one dose of the pneumonia vaccine. From 47 percent in 2014 to 63 percent in 2019. But only 23% of high risk people Those aged 19 to 64 were vaccinated in 2022. This is especially concerning for adults between the ages of 50 and 64; About half of people in the US in this group have at least one condition that increases their risk of pneumococcal pneumonia. Experts say cutting it to age 50 could help protect many in this group, including those who don’t know they have a chronic disease.
There are also practical considerations, notes Atlanta internist Sandra Fryhofer. Since the COVID pandemic, “many patients now get their vaccines at pharmacies, and pharmacists don’t know their patients the way doctors do,” he says. The new guidelines make it easier for pharmacists to recommend a vaccine based on a person’s age, even if they don’t know the person’s medical history. “We will be able to include patients who were lost,” added Fryhofer.
Lowering the eligibility age can also address health equity concerns. For reasons that are not entirely clear, blacks have a higher incidence rate of pneumococcal pneumonia in their 50s than other races at any age. “Saying ‘everyone at 50’ can narrow the differences,” says Rothberg.
What pneumonia vaccines are available and how do they work?
The new ACIP guidelines recommend that people over 50 get a jab called a pneumococcal conjugate vaccine (PCV), has one of these of S. pneumoniae sugar molecules on the surface and causes the immune system to recognize and attack that molecule. Vaccine developers attach this molecule to an inactivated toxin, which stimulates a stronger immune response when it enters the body. The guidelines specify one of two conjugate vaccines. One, PCV20, protects people against 20 types S. pneumoniae which are responsible for more than 50 percent of invasive infections in adults. The other, PCV21, includes 21 types that cause more than 80 percent of infections in adults (but does not cover a type that is seen more frequently without accommodation and in various geographic locations).
Knowing which of these types to include in a new vaccine is always a challenge, Rothberg says. The US began vaccinating children S. pneumoniae In 2000, successfully reducing the spread of the types covered by that vaccine. This reduced the number of adult infections caused by these types, but others became more common at the same time. More comprehensive vaccines are now in early clinical trials: at least one company is developing two different vaccines, one for type 24 and one for type 31.
How effective are vaccines?
There is not much long-term data on the disease-preventing ability of PCV21 or PCV20 or how long their effects last. Clinical trials suggest that an older vaccine, PCV13, is just as effective at mounting an immune response against the bacterium. A study in the Netherlands found that in adults aged 65 and older, PCV13 is about 46 percent effective in preventing pneumonia. S. pneumoniae typesit targets and is 75 percent effective in preventing an infection from becoming invasive. They are all vaccines against pneumonia much more efficient in children than in the elderly, because the immune system declines with age.
It’s unclear, Rothberg says, whether the vaccine will produce a stronger or more durable response from the immune systems of 50-year-olds than those of 65-year-olds. Loehr says ACIP will decide later whether to recommend booster shots for people who received the vaccine more than five years ago or for those who received an earlier version of the vaccine that covered fewer types.
