This article refers to adult vaccination - for information on pneumococcal vaccination in children see our article on Child immunisation

Isn't the flu jab enough?

Influenza vaccine has been shown to prevent 70-90% of cases of illness from influenza (flu) in healthy adults as well as reducing hospitalisation for pneumonia and death from influenza. All people with a range of long term health problems, including diabetes, are recommended to receive the flu vaccination. (For more information on who is eligible for the free annual flu vaccination, see our article Influenza vaccination.)

Recent studies show additional benefits in older persons who also receive pneumococcal vaccine. Pneumococcal vaccine is recommended for "persons with increased risk of pneumococcal disease or its complications", which includes diabetes. Until recently, uncertainty regarding the benefits of pneumococcal vaccine has contributed to underuse of the vaccine.

Pneumonia is an infection of the whole or part of one or both lungs, and is usually caused by a bacterium, virus or fungus. The most common cause of a bacterial pneumonia is Streptococcus pneumoniae, also called a pneumococcus. Pneumococcal infection spreads from the lung into the blood (becomes "invasive") in 20-30% of cases, and if this occurs 20-30% of these patients die.

What does the pneumococcal vaccine do?

The debate has focused around whether the vaccine truly prevents pneumonia or whether it just prevents "invasive disease", ie, the presence of pneumococcal bacteria in the blood, which is associated with a high death rate.

A number of studies clearly demonstrate a benefit for preventing invasive disease in around 50-80% of recipients but we need to look at several recent trials to decide whether the vaccine should be used routinely along with influenza vaccination in older people.

Two recent studies have clearly demonstrated the benefit of routine immunisation, one from the US involving 1898 people vaccinated with pneumococcal vaccine, and the other one from Sweden involving 100,242 people who received either pneumococcal vaccine, influenza vaccine or both.

Both of these studies show similar benefit, namely that the use of pneumococcal vaccine significantly lowered the risk for hospitalisation for pneumonia by over 50% and for death from pneumonia by over 70%. Further, they showed that during the influenza seasons included in the study, the benefits of both pneumococcal and influenza vaccinations were additive, with increased benefit being seen in those who received both.

Prevention of pneumococcal infection is important. The bacterial organism Streptococcus pneumoniae is present in the nose and throat of many people and is spread by droplets from coughing and/or sneezing. The pneumococcus is the most common cause of pneumonia in all age groups.

In severe disease it can spread through the bloodstream and involve other organs where it is associated with a higher mortality (death) rate. In recent years, we have noticed higher resistance of the pneumococcus to penicillin, the antibiotic of choice.

Currently, in New Zealand, about 12% of strains of the pneumococcus show altered sensitivity to penicillin. This has been seen worldwide and has stimulated health authorities to review the value of pneumococcal vaccination as a way of controlling these infections in the community.

Where does this leave people with diabetes in New Zealand?

First, all diabetics should receive influenza vaccination annually unless there is a contraindication (a medical reason not to).

Second, diabetics, especially those over 65 years of age, or those who have other chronic conditions such as heart disease, heart failure, emphysema and COPD, alcoholism, chronic liver disease or compromised (lowered) immunity through disease or medical treatment should consider paying for the pneumococcal vaccine. The evidence is clear; vaccination with both is better than vaccination with either one alone.

A strong case exists for funding both these vaccines in New Zealand but until this ideal is achieved, individuals who have a recognised increased risk for pneumococcal infection should pay for the vaccine themselves.

The pneumococcal vaccine is a prescription medicine, available from your doctor, lasts for up to five years and costs about $60. At an average cost of $12 per year of protection there is a substantial health benefit to be gained for many of the people described in this article.

Original material provided by Diabetes New Zealand. This article was written by Dr Richard Meech, Hawke's Bay Hospital, Hastings, first published in "Diabetes" in 2003, and edited by everybody.