The pneumococcal vaccine does much more than protect against pneumonia; it protects from long-term complications and protects families and communities through reduced transmission. Listen in and learn from experts Robert H. Hopkins, Jr., MD, and Brenda L. Tesini, MD, as they share how they discuss the full benefits of pneumococcal vaccine in their practices.
Just as pneumonia isn’t “just a cold,” the pneumococcal vaccine does much more than just protect yourself or your child against pneumonia. Listen in and learn from experts Robert H. Hopkins, Jr., MD, and Brenda L. Tesini, MD, how to discuss the full benefits of pneumococcal vaccine.
Topics covered include:
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Presenters:
Robert H. Hopkins, Jr., MD
Professor of Internal Medicine and Pediatrics
Division of General Internal Medicine
University of Arkansas for Medical Sciences, School of Medicine
Little Rock, Arkansas
Brenda L. Tesini, MD
Associate Professor of Medicine, Pediatrics, and Community Health
Division of Infectious Diseases
University of Rochester Medical Center
Rochester, New York
Link to program page:
https://bit.ly/3SuymiN
This transcript was automatically generated from the audio recording and may contain inaccuracies, including errors or typographical mistakes.
Beyond the "Pneumonia Shot": Explaining the Full Benefits of Pneumococcal Vaccines to Patients
Dr. Robert Hopkins (National Foundation for Infectious Diseases): Great. So, Dr. Tesini, great to be here with you on the - on this podcast today. You know, pneumococcal disease is a real challenge for those of us in - in practice. You know, I practice internal medicine and pediatrics. I see both adults and children. As I think back to early days of my career before we had pneumococcal vaccines, you know, otitis media, sinusitis, almost an everyday occurrence or multiple times a day occurrence in the pediatric office along with the invasive infections. The kids that, unfortunately, had pneumonia, meningitis, or bacteremia.
We see much less now, but still a significant burden of disease when we think about both the invasive and non-invasive types in children. And as we've had each new generation of pneumococcal vaccines, things have gotten better. What do you think about in that context with your adult patients?
Dr. Brenda Tesini (University of Rochester): Yeah, those are all great points, Dr. Hopkins, and yeah, I practice both adult and pediatric infectious diseases, and I'm mainly hospital-based right now. And, you know, we are still seeing in - in both adults and children hospitalizations for severe disease. So, in adults in the U.S., now, there are still over 30,000 cases of invasive pneumococcal disease.
And, I think we typically think of pneumococcus as causing pneumonia in adults, but what we see in the hospital is also the bacteremia, bloodstream infections, and meningitis. I've seen just in the last year or so, several patients with severe pneumococcal meningitis. And I think that often gets overlooked or underappreciated in the adult population, specifically when I myself will even refer to it as a pneumonia shot, but really, it's the pneumonia shot and more. It is still causing a lot of severe disease. And there was a decline in both pneumonia and more invasive disease across the ages in the early COVID pandemic, as we saw decreased circulation of respiratory viruses, but then that has really rebounded again across the ages. So, now is a really great time to have some new tools to prevent pneumococcal disease as - as we have seen this resurgence.
Dr. Hopkins: Yeah. I think we've seen that resurgence. At least in my mind, part of it's due to a decline in vaccination rates. I think part of it also is a decline in awareness in our communities, of the - of the importance of vaccination, both of our children and our adults. I think, also need to continue to emphasize that this is not just an infection that impacts people who've got chronic health conditions. We see healthy children hospitalized with pneumonia every year. We see healthy children with bacteremia every year. We see healthy children with bacterial meningitis, fortunately, much less frequently. But we see all of those in healthy people as well as in our children who have cancer and on chemotherapy, or who have sickle cell disease, or who have other high-risk conditions.
We've seen dramatic reductions in the frequency of those severe infections with our pneumococcal vaccine campaigns, looking back to the early 2000s, but we've still got a long way to go in getting where we want to be. And I know that those same paradigms affect the adult population.
Dr. Tesini: Yeah, exactly. So many vaccine-preventable diseases are - are victims of their own success. As we see it less often and people have less personal experience with the infection, then that personal reminder of the importance of getting vaccinated goes away. And unfortunately, sometimes what it takes is personally knowing someone who's had a severe infection or hospitalization or just even, you know, a really difficult otitis that, you know, the parents out of work for days in and out of urgent care and primary care. And those experiences are what I've found in practice are some of the biggest motivators for vaccination. And so as providers, I think the more that we can raise awareness and share how we are still seeing these infections will hopefully kind of keep it higher on people's minds.
Dr. Hopkins: When I think about those vaccine conversations, you know, often starting with new parents, you've got a newborn baby that's in the office for their first post-hospital discharge visit, and I'm explaining to them, we're going to start on this pathway of routine vaccination today, not pneumococcal yet, pneumococcal, we're going to start at two months. We start on this pathway because we want to provide direct protection for your child from common infections that we see every day, every week, every month in the office. And that vaccination is there not only to provide protection for that child, whether they're in day care or not, but also to provide protection for other members of the family. We typically, in primary care, use an announcement or a presumptive recommendation. You know, "Today, we're going to give your child their routine two-month immunizations, which include pneumococcal vaccine and others." Having that conversation in adults is - is similar, but a little bit different. Can you talk a little bit about how you have that conversation in the adult office?
Dr. Tesini: Yeah, I - I agree. It is a little different with adults because I think it's - it's not as common. Certainly, during infancy and early childhood, that seems to be, you know, for parents, it's kind of forefront on the mind already, and often feels like the main reason they're coming into the office is to get the shots. So, yeah, with adults for a lot of conditions, and pneumococcal disease is one of them, it's a much more kind of risk-stratified approach. And so what I found particularly helpful is really tailoring it to the patient, which is somewhat similar to because, you know, your infant is this age and is at risk for these infections, and you know, can't really protect themselves yet. We're giving these vaccines for an adult it's often because you have these conditions or because you are at this age, the other, you know, approaching the other end of life. You in particular are at higher risk for this serious infection, and that's why I'm recommending this vaccine for you.
And that seems to be the best approach, both in personal experience and studies of vaccine uptake in adults is to - to personalize it and give them the information as to why you're recommending it for them, and be explicit that you are their trusted health care provider, and your recommendation is the strongest, most important thing that's going to influence whether they'll get that vaccine. And so, coupling those two things is most helpful.
And it's - it's harder to know what people are due for, I think, in adults. So, I think it's also even more important with your adult patients to have more systematic ways of identifying who's due for what, when ahead of the visit, either through, you know, the electronic health record. For pneumococcal vaccination, CDC has what I think is a really good tool, this PneumoRecs VaxAdvisor tool. And just like other, you know, risk calculators that I think patients have gotten pretty comfortable and familiar with their provider kind of going through in the office with them, you know, here's your risk for this. You can put in some patient parameters and see if they're due for pneumococcal vaccination and what type. And - and that can be also helpful to kind of have that hard evidence.
Dr. Hopkins: Yeah. I think that why piece is the critical piece in my mind. I use that in - with my patients all the time. And the other piece that I've tried to include in there is, I'm not just talking the talk, I'm walking the walk. You know, I've had these vaccines myself, you know, at the ages where I needed them. Long ago now, but it's what it is, you know, and that I vaccinated my children, you know, that I had these conversations with my parents. You know, I want as many people protected from these diseases as possible, because I'd much rather see you in the grocery store than to see you in the hospital.
And so I think focusing on the why, I think talking about we give this pneumococcal vaccine because we want you to be able to live your life to the fullest and not have it affect your quality of life, not have it and have you missing school or missing work because your child is missing school or day care because they're sick. Not having those opportunities or threats of being in the hospital with severe pneumonia or hospitalization.
I don't talk a lot with patients and families about the cost side of things. I think we talk about those in our healthcare professional conversations and our talks with our - our leaders sometimes about supporting these systems because of cost. But I don't very often have those conversations with parents and patients. I expect you probably feel the same.
Dr. Tesini: Yeah, exactly. I think the real more emotional argument, you know, related to the impact of having yourself or someone in your household hospitalized or very sick with this infection, and how wonderful it is that we have a way to try and prevent that. And wouldn't that be great if we could prevent that?
Sometimes with older adults or with a family, a household that includes older adults, I may also bring up the impact of a hospitalization on the trajectory of the rest of that person's course that, often, hospitalizations with respiratory infections, viral and/or bacterial, can then lead to needing a higher level of care afterwards, maybe not being able to come back home. And that can often be a pretty big driver even to drive vaccination in other members of that household, can be quite helpful.
Dr. Hopkins: That comment brought a thought to mind. You know, we have a lot of success talking with older adults about getting a vaccine to protect their new grandchild.
Dr. Tesini: Yeah.
Dr. Hopkins: Maybe we need to think about it somewhat in the other direction, also. Pneumococcal vaccination is really important for your baby to reduce the risk of pneumococcal infections in grandad or great-grandad. So, thinking about that family value, maybe one that - that I don't think we emphasize enough.
Dr. Tesini: Yeah. Yeah. I think that could be really important. And especially in scenarios where you are caring for the whole family and know the other family members personally, or know that grandma or grandpa will be providing an essential role in the care of that - of that baby. Yeah. I think that would be a pretty big motivator.
Dr. Hopkins:But getting our children vaccinated is very important starting in those young ages for their own protection, but also if we have high rates of pneumococcal vaccination in the community, that reduces the rate of pneumococcal carriage in the nose and throat of children, adolescents, adults, and older adults. And we have seen a decline in rates of adults' serious infections in communities that have high rates of pneumococcal vaccination. So important for all of those groups to be vaccinated.
High-risk children and adults are going to continue to be a challenge. I've got a 14-year-old who has sickle cell disease, who was vaccinated, completed his pneumococcal series as a small child. He's still at increased risk, and so he needs additional doses of vaccine. That's going to be a challenge. I'm sure you have the similar challenge of a 65 or 70-year-old adult who had a splenectomy from trauma at age 40. You know, you've got a patient who's at increased risk. Those patients who were previously completed a series now at very high risk, are going to always be a challenge in using the PneumoRecs VaxAdvisor app can really be an important tool.
So, as we think about those clinical encounters, as we think about patients that we see every day, burden of disease decreased if we vaccinate effectively. We've seen a dip in some of those vaccination rates since the pandemic. So, as you think about your office setting, what do you see as the biggest messages for take home for your patients, for pneumococcal vaccination? And then I'll talk about the pediatric side.
Dr. Tesini: Yeah. I think really trying to capture the adult folks who may not have fit into previous pneumococcal vaccine recommendations has been the hardest population to grab at large and where I think we have big gains to make. So, it is for adults now recommended for all adults 50 and older, and adults 49 and younger who have a high-risk condition. And so, I think that the younger adult population with a high-risk condition, and high risk is diabetes, high risk is smoking. It is, you know, large portion of adult primary care panels. So, I think really getting the message out to those folks and to some of the 50 to 65-year-olds who may not have flagged before. I think that's where we have a lot of room to grow, and really getting out the message that you personally are at risk of this. It causes very serious infections. One shot and you're done. That would be my message.
Dr. Hopkins: Boy, I wish we had a one-shot and done for [inaudible]. But you know, it's so common to have the parents coming in for those two-month-old immunizations and for them to ask the question, "Well, why do they need pneumonia vaccine?" Well, pneumococcal infections are very common in young children. Pneumococcal infections can include otitis media.
I try not to mention sinusitis around two months old because they don't have sinuses [inaudible]. But I see so much less otitis media in young children now than I did in the days when we didn't have pneumococcal vaccines, or when we had only a 7-valent or a 13-valent vaccine.
So, I want your child to be able to - to enjoy their time at day care, not be sick with pneumococcal infections. Even though non-invasive infections, on the face of it, as we talk about it in a setting like this, don't seem that bad, but having taken care of those kids who've got otitis media that are miserable or a little bit older kids that have got sinusitis, or kids that have pneumonia, whether they need hospitalization or not, those kids are miserable.
Parents miss a lot of work taking care of those kids. And so, we really want to reduce those infections so those kids can get the social environment. They can learn, they can grow without potentially having important sequelae like hearing loss or other problems going down the road, you know.
So, helping parents and patients understand the value of these vaccines, why it's important to reduce this risk for the children on an individual basis, for the family unit, and for the whole community, I think, is really important.
Are there other common questions about pneumococcal vaccines in your office, Dr. Tesini?
Dr. Tesini: Yeah. I think the most common is the why, you know, getting at the why. You know, "Why me? You know, "I don't have asthma. I don't have breathing problems." So, really educating around the fact that, you know, as you go towards the ends of ages, extremes of age, everyone is at risk of this severe disease.
And then it really doesn't take much in terms of other health issues to put you at higher risk. I also like to talk about the importance of getting the respiratory viral vaccines as well, and kind of talk about all of these together. And sometimes you can use the patient's history of understanding, you know, have they been getting their flu shots? Other, you know, respiratory viral vaccines, if they're due for them, and kind of couch that all together that this whole package can help prevent some of the top causes of having to go to the hospital.
Dr. Hopkins: Yeah. I can't count the number of 50, 55-year-olds that are reasonably healthy. You know, it's - it's my - my buddy that I cycle with, you know, he says, "Hey, I'm a - I'm a - I'm 50, but I'm exercising seven days a week. I don't have any health conditions." Okay. Well, age 50, your immune system doesn't work as well as it did when you were 40 or 30, or even much better at 16 or 17, 18. So, understanding that age alone is a risk factor. And then, diabetes, heart failure, smoking. There are a number of conditions. People really don't understand what their risk is. And I think - so I think helping adults understand risk is important.
For our pediatric patients, it's not so much helping the patient understand the risk; it's helping the parent understand you're trying to do everything you can to get that safe vaccine in at a time when they're going to respond well to the vaccine and minimize the likelihood of non-invasive and invasive pneumococcal infections going forward.
And again, I'm practicing what I preach. You know, my - my kids have received this vaccine. I've received this vaccine. We want you to have the same level of protection. The CDC had a campaign for flu a couple or three years ago. Was risk less, do more. I think that really says it in a lot of ways for all of our preventive vaccines. We want you to risk less by getting this vaccine so that you can do more in your life.
Dr. Tesini: Yeah, I agree. That's a great message. And I think focusing on - for the - the pediatric side, you know, focusing on the youngest ages when they're at most risk of having it go really badly if they got one of these infections is key. I think a lot of parents now are concerned about doing things so early in life and are looking to delay things, particularly vaccines. And so, the more we can stress how, like, this is the most risky time for your baby and for your child.
Dr. Hopkins: Particularly if they're going to be in congregate settings, like day care.
Dr. Tesini: Yeah.
Dr. Hopkins: You know, it really important that you have a high level of vaccination against pneumococcal disease, against H flu type B, against these other things that are easily transmitted in the day care; flu, COVID-19, others.
Dr. Tesini: Yeah.
Dr. Hopkins: Any - any other final closing comments, Dr. Tesini?
Dr. Tesini: I think we've touched on all of the top topics that - that I get, would like. Anything from you, Dr. Hopkins?
Dr. Hopkins: I already used up my "Risk less, do more." That's what I was thinking about from my final comment.
Dr. Tesini: I love that. I also love their "From wild to mild."
Dr. Hopkins: That's right. That's right.
Dr. Tesini: For flu. Great slogan.