By Jeff Daniels EBS Medical Columnist
Pneumonia is an infection of the tissue of the lungs. It’s most commonly caused by a bacteria, but may also be caused by a virus or a fungus.
The lung tissue, normally filled with a lot of air and suffused with millions of tiny blood vessels, enables us to absorb oxygen into the bloodstream. When a segment or lobe of the lung becomes infected and inflamed by an infectious agent, that section loses its ability to absorb oxygen. Plus, the immune response to a major infection often causes other uncomfortable symptoms like fever, fatigue and cough. Pneumonia can be deadly, even in the age of antibiotics.
There are many species of bacteria that can cause pneumonia. And of these different species, or types, there can be multiple subtypes, each of which can cause an infection, even if there’s immunity to other members of the same type.
The major pneumonia-causing culprit is the bacteria known as Streptococcus pneumoniae, or pneumococcus. This bacteria is known to cause a myriad of other types of infections, especially in infants and children, where it is the main cause of severe ear infections and meningitis and can be deadly. It can also take advantage of adults who have compromised immune systems.
In adults, a select number of subtypes of pneumococcus are responsible for a majority of the cases of pneumonia that we see at the clinic. In 1983, a vaccine called Pneumovax 23 was released and has since then been recommended for people over 65 and any adult with diabetes, heart disease or a compromised immune system.
When it became apparent that Pneumovax 23 did not work well in infants and children under the age of 2, new formulations of the pneumococcal vaccine were created.
The first one was Prevnar 7, which works better in infants, even though it includes only seven serotypes of pneumococcus, versus 23 in the Pneumovax. With Prevnar 7’s success in infants and children, Pfizer created Prevnar 13 in 2010, which included six more serotypes.
Prevnar 13 now is routinely administered in four doses to infants starting at 6 weeks old and spread out over the first 2 years. It is thought that if a high percentage of kids are vaccinated, it will lower the incidence of pneumococcal disease in adults, which is great news.
The Advisory Committee on Immunization Practices of the Center for Disease Control recommends that everybody over the age of 65 receive both the Pneumovax 23 and the Prevnar 13. Some physicians disagree with this recommendation, and suggest getting only the Pneumovax 23, unless a patient has a history of smoking or chronic disease such as diabetes or emphysema.
If you’ve never received either pneumonia vaccine, the recommendation is to get the Prevnar 13 first, wait a year, and then get the Pneumovax 23. If you’ve already been administered Pneumovax 23, another shot is recommended at five-year intervals, so consider timing the Prevnar 13 a year before the next Pneumovax 23 is due. At this time, in a healthy, non-smoking adult, only one shot of Prevnar 13 is necessary.
Dr. Jeff Daniels was the recipient of the 2015 Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 800 medical students and young doctors to train with the Medical Clinic of Big Sky.