Everybody knows about vaccines, the vast majority of people who need them get vaccinated, and people only get sick from diseases that we can’t yet vaccinate against, right? Then why is this article important? The CDC released a report in 2016 with information about how many people receive the pneumococcal vaccine in comparison with how many people should be receiving it. Elderly individuals over the age of 65 are all recommended to be vaccinated, and around 60% are. However, people ages 19-64 are recommended to get the vaccine if they smoke, are heavy drinkers, have been diagnosed with a chronic diseases (diabetes, high BP, cardiovascular etc.), are healing from a serious injury or disease, or anybody with a weak immune system. That same study published by the CDC found that of this population, only about 20% have been vaccinated for pneumococcus. Of patients diagnosed with diabetes only 11% received a vaccination for pneumococcus. This may have to do with health insurance or socioeconomic status, but it also largely has to do with awareness. That is why it is important to be educated not only for yourself, but also for the people that are important to you.
The accidental discovery of penicillin by Alexander Fleming in 1928 was undoubtedly a giant leap for medicine and humankind altogether, by providing us with an effective weapon with which we can battle a large number of infectious diseases. Pneumonia, commonly caused by the bacteria streptococcus pneumoniae, is a great example of an infection that was extremely dangerous and often fatal before the era of antibiotics. However, even in the era of antibiotics, as the biologists like to often say, nothing is 100%. New generations of antibiotics have given rise to more dangerous and resistant bacteria, and even with our latest advances in biochemistry, pneumococcal pneumonia remains a very dangerous disease especially for people who are more vulnerable.
A large epidemiological study in Australia published in the 90s showed that 6.6% of children diagnosed with pneumococcal disease in Sydney died, and elsewhere the number was as high as 10% of all patients. 2/3rds of these patients were over the age of 60. In 1998 as many as 0.1% of children under the age of 5 in the US were diagnosed with invasive pneumococcal disease (IPD). IPD is a diseased caused by the invasion of the bacteria streptococcus pneumoniae into some sterile part of your body, most commonly the blood or the cerebral spinal fluid. In 2003, a study was published following patients that were hospitalized for IPD. 16.9% of patients died within 2 weeks, the vast majority in the first 3 days of the blood culture coming back with a positive result for the bacteria. These patients were treated with antibiotics. Risk factors that showed statistical significance were age (over 65yo), and other underlying illness, but however you want to look at this even in the age of antibiotics, this is undoubtedly a very deadly disease. If you’re thinking to yourself that 2003 was a long time ago and things have changed since then, think again. In 2014 a study in Belgium found a 16% mortality rate of patients with IPD in the hospital, as well as an additional 2% within one month of being released. One third of patients required admission to the intensive care unit.
In the year 2000 the FDA approved the first pneumococcal conjugate vaccine called PCV7. This vaccine trains a person’s immune system to protect them from 7 different strains of pneumococcus. There are a number of other strains that exist, however the vaccine was only for a specific 7. This was a vaccine recommended for infants with a number of doses in the first 2 years of life, and the results were instantaneous. While in 1999 in the US there were 0.96 cases of IPD for every 1000 children under the age of 5, in 2001 that number dropped to less than half, 0.41 cases/1000 . In 2002 the trend continued and dropped to 0.24 cases/1000, and the number has been dropping ever since. However along with the drop in IPD cases for small children, the vaccine also helped prevent the spread of pneumococcus to the older population as well. A study published in 2005 explored the incidence of IPD among adults over the age of 50. They found that comparing the pre-vaccine years 1998-1999 to the post vaccine years 2002-2003, the number of incidences dropped by 28%.
The updated version of PCV7 is PCV13, protecting against an additional 6 strains of pneumococcus. This vaccine was approved by the FDA in 2010, once again with positive results. The number of cases of IPD in children under 5 dropped once again from 0.20 cases per 1000 children to 0.12 cases/1000 the following year. It has since gone under 0.10/1000. Of the 13 strains that are in the vaccine, the number of documented cases in the US are under 0.02/1000 children. In 2011 the FDA approved the PCV13 vaccine for use in adults over the age of 50. A large study was conducted in the Netherlands including almost 85,000 adults. Of the adults that received the vaccine, the chances of falling ill with pneumonia from one of the covered strains was cut in half, and chances of being diagnosed with IPD was cut 75%. An additional review of 10 studies found that 9 of them concluded that the vaccine PCV13 in the elderly population was also cost-effective.
Although in the year 2000 the first conjugated vaccine for pneumococcus was approved, it was not the first pneumococcus vaccine to be discovered. In fact, in the 1940s the first vaccines were produced from the capsular polysaccharide of the bacteria. This means that scientists took specific sugar chains that were on the outside of the bacteria, isolated them, and injected them into humans in order to stimulate an immune response. Later on when the infective bacteria would enter their body, their immune systems could deal with them more easily because the cells would be able to recognize these same sugar chains and create antibodies more easily. This is in essence a more specific and effective weapon for the immune system. This discovery came around the time when antibiotics were on the rise, so it wasn’t used very widely. It was the widespread implementation of the conjugated vaccine that made such a drastic difference in the public. The conjugated vaccine takes the sugar chains, but attaches to them specific proteins that stimulate a stronger immune response. The polysaccharide vaccine today can cover 23 strains of the bacteria, 10 more than the conjugated vaccine. It is therefore recommended by the CDC that they be used together, first the conjugated vaccine and then the polysaccharide one. The polysaccharide vaccine, also known as PPSV23 is not recommended for children under the age of 2.
Knowledge is power. It’s very important for each of us to understand what our options are, and what evidence supports each option. Preventing diseases before they start is often the most efficient way to be healthy, and this starts by screening for the diseases that are appropriate for us depending on age, gender, and other factors. Download our app to go through a short list of questions, and receive a personalized list of the appropriate screening recommendations for you. More information about each of these tests is provided through the app (‘click here’ links), so that you can stay informed and educated.
If you have any more questions about the issue, or are not sure if you should be vaccinated or not feel free to contact us. Additionally, it is always best to consult your physician with medical questions.