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Pneumococcal Disease

Many people have never heard of pneumococcal disease, but if you are an adult with asthma, knowing how to protect yourself against it is very important. Having asthma makes you more vulnerable to this infection, which can lead to serious illness and even death.

Pneumococcal disease is caused by common bacteria called “pneumococcus” [noo-muh-kok-uhs] that can lead to serious, potentially deadly illnesses, including pneumonia, meningitis, and blood infections. Anyone can get pneumococcal disease, but people with asthma are at particularly high risk for serious complications.1

Infectious disease specialist William Schaffner, MD, answers important questions about pneumococcal disease, why people with asthma should be particularly concerned, and what they can do to prevent it. Dr. Schaffner is Past-President of the National Foundation for Infectious Diseases (NFID) and Chairman of the Department of Preventive Medicine and Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee.

What happens when someone gets pneumococcal disease?

Pneumococcal disease can lead to many different illnesses, depending on where the pneumococcal bacteria go in the body. The most common is pneumonia which is caused when the bacteria get into the lungs. The bacteria can also get into the bloodstream and cause sepsis or invade the central nervous system and cause meningitis. All forms of pneumococcal disease are very dangerous.2-4

Why are people with asthma at risk?

Over the years, doctors and researchers have found that people with asthma are more likely to suffer from serious pneumococcal disease. While it isn’t completely understood why, it may be because the asthmatic airway is different and the lungs may be more vulnerable to pneumococcal bacteria and infection. Use of corticosteroids, a common asthma treatment, may also increase risk.5-7 For this reason, health authorities recommend people with asthma get vaccinated for pneumococcal disease.1

How is pneumococcal disease spread?

The bacteria live in the throat and spread through coughing, sneezing, or through direct contact such as kissing. Not everyone who carries the bacteria gets sick from it, so it’s possible to “catch” pneumococcal disease from someone who seems to be healthy.

What are the signs and symptoms of pneumococcal disease?

Symptoms can vary from person to person, but generally appear very suddenly and without warning. Depending on whether the infection causes pneumonia, sepsis, or meningitis, people may have some combination of the following:

  • Abrupt onset of fever
  • Shaking/chills
  • Cough
  • Shortness of breath
  • Chest pain
  • Stiff neck
  • Disorientation

If you develop any of these symptoms, seek medical help immediately.

Can pneumococcal disease be prevented?

The best way to prevent it is by getting vaccinated.  Pneumococcal vaccination is recommended for those at risk, which includes adults with asthma. Vaccination is safe and is very effective against the most serious pneumococcal infections—meningitis and sepsis.1 Its effectiveness against pneumonia is not as clearly established, but some evidence seems to show that even if it does not prevent pneumonia, being vaccinated may help you avoid the most serious complications of pneumonia. If you have asthma and haven’t been vaccinated, ask your doctor about it. Medicare and most private insurance companies pay for vaccination for those who need it.

Who should be vaccinated for pneumococcal disease?

For adults, the Centers for Disease Control and Prevention (CDC) recommends pneumococcal vaccination for:

  • Anyone 65 years of age and older
  • Adults with asthma or any other chronic lung disease
  • Adults who smoke cigarettes
  • Adults with any of the following chronic conditions:
    • Heart, liver, or kidney disease; diabetes or alcoholism
    • Conditions that weaken the immune system
    • Cochlear implants or cerebro-spinal fluid (CSF) leaks
    • Asplenia (loss of spleen)

There are two types of pneumococcal vaccines available for adults. Adults with certain medical conditions or who require immunosuppressive treatment need to receive both vaccines. This includes adults with asthma who take treatments with corticosteroids.

What about kids with asthma—do they need to be vaccinated?

Pneumococcal vaccination has been recommended for all U.S. infants and young children since 2000. Vaccination has been very successful in protecting infants from the infection.8

Doesn’t the influenza vaccine protect against respiratory infection? Do people need both vaccinations?

People with asthma need both vaccinations. Influenza can affect the respiratory tract and cause inflammation, increasing the risk of pneumococcal infection, but pneumococcal infection can happen at any time of year, even in the summer months when flu is usually not a problem. For the best protection, people with asthma should get vaccinated against influenza every year and should also receive pneumococcal vaccination according to the CDC recommendations.

How many doses of pneumococcal vaccine do I need?

Most adults only need to be vaccinated one time, but the number and timing of doses for adults varies.

Ask your doctor about your specific circumstances.

My doctor never mentioned pneumococcal vaccination, is it new?

The CDC began recommending adults with asthma receive pneumococcal vaccination in 2008. In 2012, CDC added recommendations for a second type of pneumococcal vaccination for adults with certain medical conditions or who take immunosuppressive treatment like corticosteroids. If your doctor hasn’t discussed your risk and vaccination, ask about it as soon as possible.

This information is provided by the NFID. For more information, speak with your health care professional or visit Adultvaccination.org.

References:

1. Centers for Disease Control and Prevention. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. 2010;59: 1102-1106.

2. File TM. Community-acquired pneumonia. The Lancet. 2003; 362:1991-2001.

3. Tsai JC, Griffin MR, Nuorti JP, Grijalva CG. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis. 2008; 46:1664-1672.

4. Atkinson W, Wolfe S, Hamborsky J and McIntyre L, eds. Centers for Disease Control and Prevention: The Pink Book. Epidemiology and Prevention of Vaccine-Preventable Diseases. 11th ed. Washington, DC: Public Health Foundation 2009.

5. Hartert TV. Are persons with asthma at increased risk of pneumococcal infections, and can we prevent them? J Allergy Clin Immunol 2008 Oct; 122(4):724-5.

6. Lee TA, Weaver FM, Weiss KB. Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma. J Gen Intern Med 2007 Jan; 22(1):62-7.

7. Talbot TR, Hartert TV, Mitchel E, Halasa NB, Arbogast PG, Poehling KA, et al. Asthma as a risk factor for invasive pneumococcal disease. New England Journal of Medicine 2005; 352(20):2082-90.

8. Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases. Vaccines and Preventable Diseases: Pneumococcal Disease-Q&A. April 2010.

(Content provided by William Schaffner, MD, Past-President, National Foundation for Infectious Diseases and Chairman of the Department of Preventive Medicine and Professor of Infectious Diseases in the Department of Medicine at the Vanderbilt University School of Medicine, Nashville, Tennessee.)

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