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Most adults avoid invasive pneumococcal infections. Their immune systems fend off Streptococcus pneumoniae bacteria — also known as pneumococcus — before they can migrate beyond the nose, sinuses or throat and cause serious infections of the lungs, bloodstream or lining of the brain.
However, in some people, pneumococcus is more likely to spread to other parts of the body, leading to severe infections that require intravenous or intramuscular antibiotics. These invasive pneumococcal diseases are life-threatening infections can affect the brain (meningitis), bones (osteomyelitis), blood (bacteremia) and joints (septic arthritis).
“The diseases that concern us from pneumococcus will send you to a hospital bed or the grave,” says Robert M. Jacobson, M.D., a Mayo Clinic pediatrician. “If you recover, you could be left with a hearing deficit or a palsy.”
For that reason, healthcare professionals recommend the pneumococcal vaccine for adults with the following risk factors.
Chronic heart disease
People with chronic heart disease tend to have elevated levels of fluid in their lungs, altered blood and lymph circulation, and a greater amount of stress on the spleen, which has important blood-filtering and infection-fighting roles.
“This makes it harder for the body to filter its blood and clean out bacteria,” says Dr. Jacobson.
Specifically, congestive heart failure and heart valve disease put you at a nearly 10 times greater risk of developing invasive pneumococcal disease such as meningitis or bacteremia. In contrast, vaccination can reduce your risk of death from pneumococcal disease by 22%.
Smoking and excessive alcohol consumption
Smoking and alcohol misuse are considered the most preventable risk factors for invasive pneumococcal disease.
Smoking can injure the delicate lining of the lungs, making it more porous and allowing bacteria to enter the bloodstream. Similarly, long-term alcohol use can alter the immune system as well as the respiratory tract, making it more difficult for the immune system to clear bacteria from the body.
Chronic lung disease
Like smoking, chronic obstructive pulmonary disease (COPD), emphysema and asthma can all injure lung tissue, which increases the risk of bacteria getting into the bloodstream. People with these conditions are more likely to be hospitalized with pneumococcal disease.
Diabetes
People with type 1 and type 2 diabetes are nearly six times more likely to develop invasive pneumococcal disease than are people who don’t have diabetes.
The mechanism of how diabetes increases this risk of invasive pneumococcal disease isn’t fully understood. However, medical professionals suspect that diabetes may increase the risk by affecting the small blood vessels. As elevated blood sugar levels injure tiny vessels throughout the body, small leaks become more likely, making it easier for bacteria to spread.
Cerebrospinal fluid leaks
Cerebrospinal fluid surrounds the brain and spinal cord, serving as a cushion and protecting both from injury. This fluid also forms a barrier that keeps bacteria and other pathogens out of the brain.
“We have certain parts of our body that are sealed off, even from our bloodstream,” says Dr. Jacobson. “Bacteria in the blood can’t reach the brain unless the blood-brain barrier is broken.”
Several layers of tissue help keep cerebrospinal fluid where it belongs. However, some medical procedures, health conditions and injuries can puncture these protective layers of tissue, allowing fluid to leak and bacteria to gain a foothold, raising the risk of meningitis.
Cochlear implants
A cochlear implant connects an external transmitter from behind the ear to a surgically implanted electrode that collects impulses and sends them to the auditory nerve.
“The implant creates a cerebral spinal fluid portal, connecting the lining of your brain with the outside world,” says Dr. Jacobson.
Though the procedure can have life-changing benefits, it can also increase your risk of meningitis. However, by getting a pneumococcal vaccine before the cochlear implant procedure, you can dramatically reduce the risk of this complication.
Reduced immunity
Several health conditions and medical treatments can reduce immunity, making it easier for bacteria like pneumococcus to spread unchecked. These conditions include:
- Chronic liver disease.
- Chronic kidney disease.
- Human immunodeficiency virus (HIV).
- Any health condition treated with immunosuppressive drugs.
If you know you will soon be taking a medicine that reduces the effectiveness of your immune system, see if you can get vaccinated ahead of time.
“The vaccine’s effectiveness depends on the response from the immune system,” says Dr. Jacobson.
By getting the vaccine while your immune system is strong, you have a better chance of developing immunity to pneumococcus.
Read more about the pneumococcal vaccine for people who are immunocompromised.
Being 65 or older
The older you are, the less robust your immune system. You’re also more likely to have a health condition, such as heart disease or diabetes, that also raises your risk of invasive pneumococcal disease.
Vaccination recommendations
Healthcare professionals recommend the pneumococcal vaccine for adults with one or more of the risk factors mentioned above.
Vaccine timing
Your healthcare professional will likely suggest that you receive one of the following:
- A single dose of pneumococcal conjugate vaccine, such as PCV20 or PCV21.
- A dose of PCV15 followed by a dose of the pneumococcal polysaccharide vaccine (PPSV23) at least one year later.
However, if you will soon undergo a procedure — such as a cochlear implant — your healthcare professional may recommend a different schedule to ensure you’re fully vaccinated beforehand. You might get the second PPSV23 dose as soon as eight weeks after your initial PCV15 dose.
Vaccine side effects
Typical side effects include soreness at the injection site. You may also experience other symptoms related to your immune system responding to the vaccine. These include fatigue, headache, and muscle and joint pain.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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