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 son’s 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.
Pneumonia and the flu are not the same thing, of course. The flu is a viral infection caused by the flu virus, and pneumonia is usually caused by bacteria like Streptococcus pneumoniae (sometimes also called pneumococcus). However, people who get the flu are more likely to get pneumonia, which is why the flu shot is often cited as a way to prevent pneumonia. But the flu does not “turn into” pneumonia as many people say. What happens is that after being infected with influenza, they then get a secondary infection with pneumococcus. Thus the main ways to prevent pneumonia are to get the flu shot, get the pneumonia vaccine, and of course quit smoking.
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.
There are essentially two types of pneumonia vaccines. The first type is a pneumococcal polysaccharide vaccine (PPSV), which was first introduced in 1977 and protects against 23 types of pneumococcus. It is usually sold under the name Pneumovax-23. However, there is also a newer pneumococcal conjugate vaccine (PCV), which is usually sold as Prevnar-13 or Prevar-7 or Synflorix depending on whether it protects against 13, seven or 10 serotypes.
At first look, the Pneumovax-23 vaccine would seem obviously superior since it protects against more pneumonia strains. But the conjugate Prevnar vaccine offers some other advantages. Whereas Pneumovax-23 is not effective in infants and children, Prevnar-13 is. Also, the Prevnar conjugate vaccine can stimulate an immune response in the mucosal lining of the nose, which is where most bacteria live. This has the indirect effect of making it less likely that you will pass on the bacteria to someone else. In addition, Prevnar-13 protects against serotype 6A, which is not found in the Pneumovax-23 vaccine, and the immune response of Pneumovax tends to wane after five to 10 years, which might require a booster.
While there is an obvious benefit for children, it is not really clear whether adults should get one or both vaccines. The CDC recommends people over 65 have both, whereas Health Canada is more ambivalent (though it does recommend both in people with weakened immune systems). The incremental benefit of getting both if you’ve already had one vaccine might seem small, especially if you are asked to pay out of pocket. Also, while Pneumovax and Prevnar protect against the most common pneumoccocus strains that cause pneumonia, more than 90 such strains exist, so they do not offer 100 per cent protection. Still though, the pneumonia vaccine will go a long way to reducing your likelihood of getting very sick.
And if you won’t listen to me, at least listen to Oprah.
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