Your Good Health: You can get pneumonia even when vaccinated

Dear Dr. Roach: When I was 55, my doctor recommended that I have the pneumonia vaccination, and a booster a couple of years ago. I am 72 now. Is it likely Hillary Clinton would have got one? Can you get pneumonia after having the vaccination? If so, why would it be recommended, and are they harmful?

S.M.

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I don’t know whether Mrs. Clinton was vaccinated. However, expert groups recommend vaccination. The current recommendation from the U.S. Advisory Committee on Immunization Practices is to get the PCV13 (Prevnar) at age 65, followed by a dose of PPSV23 (Pneumovax) six to 12 months later. Adults over 18 also should receive these two vaccines if they have a condition that compromises the immune system, or certain other medical conditions. Some experts recommend only the Pneumovax for healthy elderly.

No vaccine is perfect, so it is still possible to get pneumococcal pneumonia (pneumococcus is the bacteria responsible for the most common and one of the most serious types of pneumonia) after vaccination. There are many other types of pneumonia caused by organisms other than the one covered by the vaccine.

The best estimate is that the vaccine prevents 50 to 80 per cent of severe pneumococcal disease. The most common side effects are a sore or swollen arm. Serious reactions are rare. Because of the significant benefit and small risk of harm, I recommend at least the PPSV23 pneumococcal vaccine for those over 65.

 

Dear Dr. Roach: I have a friend who is an older male with diabetes that is controlled by oral medication. He has cataracts in both eyes. He told me he has some sort of infection “way inside” one eye, and the eye specialist is suggesting he have both cataracts done at the same time. I’m a bit concerned, not only because of the infection for which he takes drops, but also, isn’t doing both eyes at one time a bit risky for anyone? He lives alone and has to go out of town to get the surgery done. Should he seek a second opinion?

S.C.

There are two parts to this question, and I don’t understand the first part, which is why do cataract surgery on someone with a deep infection of the eye. I think there might be a miscommunication here, since endophthalmitis is a feared infection that is a complication of cataract surgery, and it is more common in diabetics. If he had an existing infection now, he would need that treated before having cataract surgery.

The second issue is whether it is safe to do both cataract surgeries at the same time.

Eye surgeons do not agree on whether there are higher risks in doing both surgeries on the same day. Fear of development of endophthalmitis is one argument against doing both cataracts on the same day. In other countries, it is much more routine to do both at the same time, and most studies have shown that it is very safe. Given that he has to go out of town, it might make more sense for him to do both at the same time.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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