Pneumonia vaccine order matters

Dear Dr. Roach: My doctor recommended both pneumococcal vaccines for me.

He recommended the PCV-13 (Prevnar) first, followed two months later by the PPSV-23 (Pneumovax). He also told me that if I had them in the reverse order, I would have had to wait a full year between the shots, not just two months. Why is that?

R.S.

Answer: I’m afraid the recommendations are a bit confusing.

Not everyone is recommended to have the PCV-13 (Prevnar) vaccine now. Since 2000, when the vaccine began being given routinely to children, the amount of disease caused by the strains of the bacteria covered by the vaccine has drastically reduced, showing that children were carrying the bacteria that led to older adults getting sick.

Consequently, there’s less of a benefit of giving the vaccine than there used to be. People with high-risk conditions—say, anim mu no com promising condition, spinal fluid leak or cochlear implant — definitely should get the vaccine; otherwise, you and your doctor should discuss whether it’s needed for you.

The PPSV-23 (Pneumovax) is recommended for everyone at 65, and for younger people with a variety of medical conditions, including sickle cell disease, kidney failure and many cancers in addition to the indications for the PCV-13. A person who got it at a young age should get a second dose at age 65, at least five years after the first dose.

As your doctor correctly said, people who get both should get the PCV-13 first, then the PPSV-23. Generally healthy people are recommended to get the PPSV-23 a year after the PCV-13. Giving the two vaccines a year apart leads to higher levels of antibodies, based on clinical studies.

However, people with medical conditions requiring both vaccines should get the PPSV-23 eight weeks after the PCV-13, because we want them protected sooner, and that particular order still leads to good levels of antibodies of the strains of pneumococcus that are in both vaccines.