Pneumococcal Pneumonia and the Pneumovax

Pneumonia can be caused by many different species of bacteria and viruses, but the most common cause is a type of bacteria called pneumococcus or Streptococcus pneumoniae. Some estimates are that pneumococcus is responsible for as many as half of all cases of pneumonia acquired outside of a hospital. This is an increasing threat as more and more strains of pneumococcus are becoming resistant to common antibiotics, making them harder to treat and requiring more frequent hospitalizations.

Typically, a case of pneumococcal pneumonia is characterized by the sudden onset of fever, chills, cough, and chest pain. When compared to patients with pneumonia caused by other types of bacteria, patients with pneumococcal pneumonia tend to recover more quickly and experience fewer complications. People with weakened immune systems have a greater chance of developing pneumococcal pneumonia. Cases of pneumococcal pneumonia are most common between November and April.

When a doctor suspects that a patient has pneumococcal pneumonia, he or she usually orders a chest x-ray which can show an infiltrate or shadow in one or more regions of the lung. Additional tests are not always performed but may include microscopic review of the sputum and various blood tests, including a white blood cell count and blood cultures.
Treatment of pneumococcal pneumonia consists of antibiotics either intravenously or by tablets, depending on the severity of the illness. For uncomplicated cases, antibiotics are usually given for five to seven days.

The Pneumovax vaccine is available for the prevention of pneumococcal pneumonia and is recommended for people at high risk of developing pneumococcal disease, or who are more likely to develop a serious complication of infection. The groups targeted for vaccination include all people over the age of 65 and people with certain illnesses including chronic pulmonary disease, advanced heart disease, diabetes mellitus, alcoholism, cirrhosis of the liver, chronic kidney disease, spleen absence or dysfunction, weakened immune system, or sickle cell anemia.

If a person has had a Pneumovax vaccine before the age of 65, he or she should receive a second dose after age 65 if five years have passed since the first dose. If the initial Pneumovax vaccine is obtained after age 65, no further vaccination is required. A second dose is also recommended five years after the first dose for people who have certain conditions that weaken the immune system or have chronic kidney disease.

About one-third to one-half of people who receive the Pneumovax experience mild side effects such as redness or pain at the site where the injection was given. These symptoms usually resolve within 48 hours. Rarely, people may develop fever, muscle aches, or more severe reactions at the site of the injection.

Unfortunately, the Pneumovax is most effective in preventing pneumococcal pneumonia in younger and relatively healthier people, but less effective in preventing disease in older people or in those with weakened immune systems. However, even in these groups in whom the Pneumovax is less effective, the vaccine seems to prevent some of the complications of pneumococcal pneumonia.

Although the Pneumovax is beneficial, it is important to remember that it does not prevent all cases of pneumococcal pneumonia, although it often reduces the severity of the disease. In addition, it provides no benefit in preventing cases of pneumonia caused by viruses or by species of bacteria other than pneumococcus.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.