Pneumonia Vaccines

What is pneumonia?

Pneumonia is an infection of the air sacs (alveoli) in the lungs. There are more than 30 different causes of pneumonia. A pneumonia infection can be viral, bacterial or fungal. There are more than 90 different strains of Streptococcus pneumoniae, the most common bacterial pneumonia. It is often found in the upper respiratory tract of healthy people, especially children, where it is generally harmless or causes mild illnesses such as bronchitis, sinusitis, and ear infections. A severe form of pneumonia can develop when the bacteria moves from the upper respiratory tract to other parts of the body, leading to life-threatening diseases such as sepsis, meningitis and invasive pneumococcal disease.

Like other respiratory infections (colds, flu, RSV, bronchitis, Covid-19) most people get pneumonia after inhaling respiratory droplets from an infected person’s coughing, sneezing or talking. It can also be contracted by touching a contaminated surface. Fungal pneumonia is much less common than viral or bacterial pneumonia but you can get it from gardening if you breathe in spores from fungi in soil that has been contaminated such as from bird droppings. 

It may be difficult to tell if you have pneumonia. It could be bronchitis which is inflammation of the pathways (bronchioles) that carry air to the lungs. 

Like pneumonia, bronchitis is characterized by a cough, chest congestion and fever. Bronchitis is usually a viral infection so antibiotics are not effective. Contrary to what is said on many websites, the color of the mucus that is coughed up is not a reliable indicator as to whether the infection is viral or bacterial. Clear mucus turns yellow as the immune system begins to respond and becomes green as the immune response intensifies. This change in color can occur with both viral and bacterial infections.

Treatments for bronchitis include various home remedies such as honey, hot tea and other liquids. Using a vaporizer to keep the air moist may make it easier to breathe. There are also many over the counter medicines. Particularly effective are expectorant cough medicines with guaifenesin such as Robitussin, Mucinex and Buckley’s. They dilute the mucus, making it easier to cough up and clear the air pathways for breathing.

Colds, flu and bronchitis can lead to pneumonia. Your immune system and general health may be weakened from fighting the viral infection making it easier for the virus and other bacteria to infect your lungs, causing pneumonia. Distinct signs of pneumonia are a high fever (over 39° C/102° F), specs of blood in mucus, shortness of breath and difficulty breathing.

A doctor may be able to diagnose pneumonia from your symptom history and by listening to your breathing. A chest X-ray provides a more definitive diagnosis. Blood tests cannot diagnose pneumonia but they can help detect whether you have an infection and its severity. A laboratory analysis of a mucus specimen is also possible but this is somewhat unreliable due to the risk of contamination of the specimen and it takes several days. Rather than waiting, if pneumonia is suspected a doctor will generally prescribe an antibiotic. But there are many different antibiotics for the different strains of pneumonia and it is somewhat of a guess as to which one will work. There are a few antiviral medicines for pneumonia but several of them are not very effective unless they are administered within 48 hours of the onset of symptoms.

If your condition worsens, you need to go to the hospital. Signs of severe pneumonia infection are rapid breathing, severe shortness of breath, chest pain, coughing up large amounts of blood, bluish color on fingernails, lips or skin and high fever (above 40°C/104°F).

In hospital you are given a tube that clips on your nose to provide oxygen. This will make it easier to breathe as the supplemental oxygen compensates for the oxygen that you can’t get from your congested lungs. You will be started on an intravenous antibiotic. This delivers more antibiotics more quickly than by using pills. They will start with a combination of several antibiotics. If you don’t improve in a couple of days, they will change to another antibiotic cocktail. It is possible that none of the antibiotics administered in the hospital help you recover if your pneumonia is a viral infection. It may be largely up to your immune system to bring about your recovery.

Pneumonia is a serious illness. The fatality rate of people aged 65 or more who are admitted to hospital for pneumonia is up to 15%. 

Fortunately there are vaccines to help protect you against pneumonia.

Pneumonia Vaccines

Prior to 2021, adults were recommended to get two vaccines: Prevnar 13 followed by Pneumovax 23 six months later. 

Prevnar 13 helps protect against 13 types of pneumonia bacteria (approved in 2010-2013).

Pneumovax 23 targets 23 types of pneumonia bacteria (approved in 1983).

Many different types of pneumonia bacteria circulate in the population. The most common types that cause disease can vary across different populations and tend to change over time, leading to the development of newer vaccines over the years.

Prevnar 20 (Pneu-C-20) was approved by the FDA and Health Canada in 2021/2022. It protects against 20 types of bacteria, including all those covered by Prevnar 13 plus 7 additional strains that are responsible for a significant portion of pneumonia cases.

Pneu-C-21 (CAPVAXIVE) was approved in 2024. It only protects against one more type of bacteria than Prevnar 20 but about half of the bacteria types it targets are different from those targeted by Prevnar 20. The drug company claims that overall, Pneu-C-21 protects against bacteria responsible for 84% of pneumonia cases in adults compared to 52% by Prevnar 20. Their analysis is based on CDC data from 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee). The prevalent pneumonia bacteria strains where you live could be somewhat different.
Merck Analysis

Recommendations

The Centers for Disease Control and Prevention recommends pneumococcal vaccination for children younger than 5 years and adults 50 years or older and for children and adults of other ages who are at increased risk.
CDC Recommendations

The National Advisory Committee on Immunization in Canada (NACI) recommends either Prevnar 20 or Pneu-C-21 for adults aged 65 or older or younger adults with certain health risks, even though Pneu-C-21 seems to offer distinctly better protection than Prevnar 20.
NACI recommendations

For those who haven’t received any pneumonia vaccine, a single dose of Prevnar 20 or Pneu-C-21 is sufficient to provide comprehensive protection. 

For those who have already received Prevnar 13/Pneumovax 23, it is advised to get either Prevnar 20 or Pneu-C-21 five years later.

You may have to pay for a Prevnar 20 or a Pneu-C-21 vaccination depending on where you live and your health plan. Some drug stores are not aware that Pneu-C-21 is the latest pneumonia vaccine. If you get your doctor to send in a prescription for CAPVAXIVE they can order it.