Should I Get the Pneumococcal Vaccine? 5 Things to Know

Should you get vaccinated against pneumonia? That’s a new question for tens of millions of people since newly updated federal guidelines lowered the eligibility for adults to get the pneumococcal vaccine to age 50. Previously, only children under 5 and adults 65 and older were advised to get the shot, which protects against pneumococcal pneumonia—the most common type of bacterial pneumonia.

Anyone of any age can get pneumonia, a lower respiratory tract infection that causes coughing, fever, chest pain, and, in severe cases, breathing trouble, which can lead to the need for supplemental oxygen or even mechanical ventilation. While there are more than 30 different bacterial, viral, and fungal causes of pneumonia, pneumococcal is one of the only bacterial causes for which there is a vaccine.

People at both ends of the age spectrum are at especially high risk for pneumococcal pneumonia, as are those ages 19 to 49 with underlying conditions or risk factors (more on that below).

The new guidance is based on recommendations from the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices (ACIP). In the United States, an estimated 150,000 people go to the hospital each year for pneumococcal pneumonia, and one in 20 dies as a result.

Although older age is considered a risk factor for pneumonia, “age 50 is when we start to see certain age-related medical problems pop up that may put people at higher risk for pneumonia,” says Scott Roberts, MD, a Yale Medicine infectious diseases expert. “So, I certainly agree with lowering the age of eligibility for the pneumococcal vaccine.”

Dr. Roberts and Annette Cameron, MD, a Yale Medicine pediatrician, answered five questions about the updated pneumococcal vaccine recommendations and why it’s important to protect against all types of pneumonia.

Pneumococcal pneumonia is the most common cause of community-acquired pneumonia, meaning the infection was contracted in the community rather than in a hospital or other health care setting.

The culprit is a bacterium called Streptococcus pneumoniae (or S. pneumoniae), which spreads through contact with respiratory secretions, like saliva and mucus, and through coughing, sneezing, or close contact with an infected person.

A person might develop a pneumococcal infection alongside a respiratory disease such as COVID or the flu. "That’s because your immune system is already weakened from the respiratory illness, so you are more vulnerable to a bacterial infection on top of the illness you already have,” Dr. Cameron says.

The danger of any kind of pneumonia is that it makes the air sacs in one or both lungs fill up with fluid or pus, which can lead to breathing problems and, in the worst cases, respiratory failure. “Typically, an infection first occurs in an individual’s nose,” says Dr. Roberts. “Some people are able to clear it, and they're fine. But if not, the infection goes deeper, and the person experiences lower respiratory tract symptoms, such as cough, fever, chest pain, chills, and difficult or rapid breathing.”

A pneumococcal infection can also lead to diseases other than pneumonia, including an ear or sinus infection and more invasive conditions such as meningitis (an infection in the membrane surrounding the brain and spinal cord) or bacteremia (a bloodstream infection). “The latter two are the ones we're worried about the most,” Dr. Cameron says. “Those can be fatal, especially in very young children, older adults, or people with certain underlying conditions.”

There are four vaccines available, each one targeting a different variety of serotypes—essentially strains—of pneumococcal bacteria.

For most people, the CDC recommends one of three pneumococcal conjugate vaccines (PCV15, PCV20, and PCV21—the numbers address the number of strains the vaccine targets). These vaccines have been available for more than 20 years and can prevent even mild infections because they provide what’s called “nasal immunity.”

The nasal passages are often the first point of contact for inhaled pathogens. Nasal immunity helps prevent these pathogens from establishing an infection in the respiratory tract. The vaccines stimulate the production of antibodies in the moist tissue that lines the nasal cavity, preventing the colonization of bacteria in the nasal passages.

There is an older non-conjugate vaccine called pneumococcal polysaccharide vaccine 23 (PPSV23) that does not provide nasal immunity but protects against severe complications from more serotypes than the other three vaccines.

Dr. Roberts recommends asking your primary care provider about which one is available and best for you.

The CDC provides more information about the different types of pneumococcal vaccines.

The pneumococcal shot is estimated to be at least 50% effective in reducing invasive pneumococcal disease; it may be more effective depending on the age and health of the recipient.

The pneumococcal vaccine is considered safe. The most common side effects are drowsiness, fever, headache, loss of appetite, and a sore or swollen arm from the shot, all of which are mild and last no more than a day or two.

While severe allergic reactions are rare, it’s important to call 911 if there are any symptoms of a severe allergic reaction, such as dizziness, hives, a fast heartbeat, difficulty breathing, swelling in the face and throat, and weakness.

The pneumococcal vaccine is given at two stages of life—it’s a routine vaccination given four times in childhood and is given again, in most cases as a one-time shot, to older people.

Specifically, the pneumococcal vaccines are recommended for the following groups:

• All children younger than 5 years are recommended at the following ages:
  • 2 months
  • 4 months
  • 6 months
  • and 12 through 15 months
• All adults ages 50 and older
• Any child or adult who is at increased risk for pneumococcal disease

People can be at risk for pneumococcal disease for different reasons. Children ages 2 and younger are at increased risk for pneumococcal pneumonia and experiencing severe illness because their immune systems are still developing; older adults are less able to fight off infection than when they were younger. People who are pregnant also may want to talk to their doctor about the vaccines, since they are at higher risk for various reasons, including the fact that the uterus is expanding, resulting in reduced lung capacity.

Preventing infection is also important for people with illnesses that can worsen their prognosis. These illnesses include autoimmune diseases; cancer; and chronic heart, lung, or kidney disease. Cigarette smoking or working in an area where there are environmental hazards, such as toxic fumes or chemicals, are also risk factors.

Dr. Cameron says this type of bacterial pneumonia can also spread among children and adults who spend time in close quarters, including young children who attend childcare programs. “This also can apply to people who live in a nursing home or any type of communal living, including the military,” she says.

You can get a pneumococcal vaccine at any time of year, and most insurers will cover it, Dr. Roberts adds.

In addition to getting the vaccine, it’s important to take measures to prevent any kind of pneumonia. It can be especially critical considering that the pneumococcal vaccine doesn’t protect against non-pneumococcal pneumonia—the types caused by other bacteria, viruses, and fungi.

The same steps that help prevent other infectious diseases can also help protect against pneumonia. These include:

• Washing your hands
• Maintaining a healthy diet
• Getting adequate rest
• Exercising regularly
• Not smoking

In addition to getting the pneumococcal vaccine, it helps to get the recommended vaccines for flu, COVID-19, and RSV, since those vaccines help prevent complications from those diseases, which includes pneumonia.

If you do get pneumococcal pneumonia, it can be treated with antibiotics. “But prevention is always better than treatment,” Dr. Roberts says. “S. pneumoniae is a different beast because it can lead to invasive disease really quickly. I've seen devastating complications where a person was sick and stayed home for three days before they finally came to the hospital, but complications had already occurred. This is all preventable with the pneumococcal vaccine.”

He recommends getting medical attention right away if there are signs that a respiratory infection is entering the lungs—for instance, if the symptoms include trouble breathing, coughing, and wheezing. “Regardless of what the pathogen is, I think that's when I would let my doctor know and go in and get my vital signs checked to make sure I'm OK,” he says.

Additional reporting provided by Lorie Parch.