Why everyone 50 and older needs the pneumonia vaccine

Pneumonia, an infection of one or both lungs caused by bacteria, viruses, fungi or chemical irritants, is one of the main reasons people wind up in a hospital. It can quickly become life-threatening; as many as 1 out of every 20 adults who gets pneumonia may die, depending on factors such as where the patient can safely be managed, the patient's age and how severe the disease is.

The good news is: It can be preventable in many cases, thanks to a one-time vaccine. Unlike the annual flu vaccine, the pneumonia vaccine is a one-and-done. Or, in some cases, a two-and-done. (We’ll explain a few paragraphs below.)

Dr. Kyle McMillen tries, ever so gently, to impress upon his patients why it’s important for everyone over 50 to get the vaccine.

“The biggest reason to get it is that you can get really sick without it,” said the internal medicine doctor with Novant Health New Riverside Primary Care in Bluffton, South Carolina. “The vaccine is extremely effective at preventing severe disease. It doesn’t necessarily prevent you from getting sick, but it is likely to prevent you from ending up in the hospital.”

We asked McMillen what else people should know about pneumonia.

Who needs the pneumonia vaccine?

Until October 2024, the recommendation was for people 65 and older to get it. But the Advisory Committee on Immunization Practices (ACIP), a division of the Centers for Disease Control and Prevention, expanded their recommendation to include everyone 50 and older. (Click here for a full list of CDC vaccine recommendations.)

The vaccine is also indicated for adults under age 50 who smoke or have a chronic illness like asthma, diabetes or heart disease.

A couple of years ago, the pneumonia vaccine was two vaccines, just as the shingles vaccine is. But a friend recently got the pneumonia vaccine, and it was a single shot. Did that guidance change, too?

There is a two-shot series and a newer, single vaccine. Your friend probably got one of the newer ones— either PCV20 (Prevnar 20) or PCV21 (Capvaxive).

It gets confusing because there are actually four different pneumococcal vaccines available that are recommended by the ACIP. Besides the ones I just mentioned, there’s also PCV15 followed, at a later appointment, by PPSV23. But that two-shot series has essentially been replaced by the PCV20 or PCV21 as a single shot.

Which one you get comes down to your age, vaccination history and risk factors. Your doctor can determine which is best for you. The important thing to note is:

• If you get PCV15, you need to get PPSV23 later.
• If you get PCV20 or PCV21, you’re done.

If you need two doses, they’re usually given a year apart, and you get the same vaccine each time. That guidance can vary for patients who are immunocompromised, but the minimum interval between shots is eight weeks.

Although there are other types of pneumonia, what we vaccinate against is pneumococcal pneumonia, because it accounts for as much as 30% of all hospitalized pneumonia cases in the U.S.

If we could get more people vaccinated, we would have a much better chance of reducing serious disease. With pneumonia, the overall case fatality rate is as high as 25% for certain people (again, depending on age and severity of disease) who end up in the hospital. So, this is not a benign disease we're trying to prevent.

Is the pneumonia vaccine apt to make you feel like you have the flu? I know the shingles vaccine has that effect on a lot of people.

A lot of people feel a little run down afterward. That’s to be expected because it’s designed to aggravate the immune system. Your body identifies a problem and then mounts a response. That’s so the next time you get exposed to it, the response happens much faster, and the bacteria doesn't have as much of a chance to replicate in your body and lead to overwhelming symptoms.

I recommend giving yourself a day or two to recover if you’re predisposed to feeling ill after a vaccine. Have it on a Friday, for instance, and take the weekend to recover. Any symptoms you may feel shouldn't be a lingering thing.

What are the symptoms of pneumonia?

A cough, shortness of breath and fever. And the biggest one is the cough. It happens almost 90% of the time. If your respiratory rate increases – meaning how fast you breathe – that’s another indicator.

You might feel sweaty, have the shivers, aches and chest pain, especially when you take a big, deep breath.

Can a bad cold turn into pneumonia?

You can get what’s called post-viral pneumonia or bacterial pneumonia after a viral illness like the flu. It’s a different type of disease process. Upper respiratory syndrome can occasionally progress to a pneumonia. If you haven't kicked an upper respiratory infection in seven to 10 days, it’s probably worth seeing your doctor about possibly starting some pneumonia treatment.

How is pneumonia treated?

With antibiotics, usually.

But we always have to weigh: Is the patient likely to beat it themselves, or is it something that’s unlikely to get better on its own? The overuse of antibiotics is a big concern in the medical community because that can lead to the evolution of antibiotic-resistant bacteria. We don’t want to prescribe an antibiotic unless it’s absolutely necessary.

The only way to know the answer if you can beat it on your own — or if you need an antibiotic — is to do labs. We need to know how severe the disease is.

Have you seen vaccine skepticism among your patients, and, if so, how do you combat it?

Unfortunately, we have. Things we can overcome are some of the misconceptions portrayed on the internet from non-verified sources. There’s so much misinformation out there that it can definitely be confusing, and people truly may not know what the official recommendations are. So, as a healthcare community, we have an opportunity to set the record straight.

The single vaccines I mentioned earlier — PCV20 (Prevnar 20) and PCV21 (Capvaxive) — have been really beneficial. It’s so much easier to tell people they need just one shot. And since nearly all primary care offices in the Novant Health network offer those, patients who are interested can just walk a few steps to the lab and get it. The single vaccine has been very helpful for combating hesitancy.

But if someone wants the vaccine and doesn’t have an upcoming appointment with their doctor, they can probably get it at any pharmacy, right?

Certainly they can if that’s more convenient.

Anything else you want to share?

It’s important for everyone to work together. You want to limit population spread, prevent disease and decrease occurrence. We can all help each other out by getting the vaccine.

Secondly, people can go to CDC.Gov/Vaccines to find out about the pneumonia vaccine and all the other vaccines recommended for adults and children.

I want to stress the importance of this: Currently, the best way to prevent severe disease is through vaccination.

And it’s not just about your health. It's about the health of everyone you’re around. Improving community health is one of our big goals.

So, even if you’re under 50 and healthy, if you’re regularly seeing your elderly parents or anybody else in a high-risk category, should you get the vaccine?

That’d be a good idea.