Pneumovax

[shornoff]

I had a Pneumovax vaccination in 2011 when I was 64. I was diagnosed with CLL in 2017. Should I ask my doctor for another one or is one enough?

Many thanks.

[cllady01 Former Volunteer]

This 2021 publication should answer your questions, and if not, sharing it with your Dr. can surely get some answers to clarify timing for any re-vaccinations in U.K. for immunocompromised and elderly.

ncbi.nlm.nih.gov/pmc/articl...

[CLLerinOz Administrator Volunteer]

Yours is an interesting question because, technically, healthy people are said to develop lifetime protection from a single pneumococcal vaccination.

CLL patients, on the other hand, need extra help to develop protection and a two vaccine regimen is recommended for them, with a five-year 'booster'.

We know that CLL can impact our immune systems long before we are diagnosed, so it's hard to say whether you would have responded as a healthy person to that 2011 vaccine or not. However, your CLL does make you more susceptible to infections.

Also, since 2011, prevnar13 has been approved and those that are immune compromised respond much better to this vaccine than pneumovax23. Another vaccine has also been introduced in some places: prevnar20, which provides protection against a further 7 serotypes (20 vs 13)

As a result, I think it's a good idea for you to discuss re-vaccination with your doctor.

This time, the protocol you'd follow would be the one for pneumococcal vaccination in the immunocompromised in the UK. This pinned post which is maintained by PaulaS will give you more information about that and about the recommended timing between vaccines:

healthunlocked.com/cllsuppo...

You've written before about bouts of CFS so I'm including this helpful information from the ME Association in the UK about pneumococcal vaccination in that population: meassociation.org.uk/medica...

[CaptRon1976 in reply to CLLerinOz]

In the US one can get a pneumococcal 23 strain titre done. Unfortunately after my Prevnar 20 last fall my titres were still low and therefore the vaccination was considered a fail as I didn’t make enough antibodies. If you can get this test it may tell you that you have good antibodies now and consequently might not need the Prevnar or Pneumovax again. Although it surely wouldn’t hurt to get it.

[shornoff in reply to CLLerinOz]

Thank you. That information is much appreciated.

[RZ8983DV]

I have had both Prevna r and Pneumovax about a year after diagnosis in 2009 but not had any boosters since. I have asked my GP about it on several occasions but they say I don't need extra anti pneumonia vaccinations. Still on W and W 14 years after diagnosis

[thb4747]

I was diagnosed in 2001, had Pneumovax vaccinations in 2017, got pneumonia in 2019 and 2020 and have just had follow up Pneumovax. I don’t believe doing it once enough. Go for it!

[PaulaS Volunteer]

It saddens me that so many doctors are still not aware that Prevnar 13 (or Prevnar 20 if you can get it), is much more effective than Pneumovax for immuno-compromised people.

shornoff , I suggest that if you haven't already had Prevnar, ask your doctor for it asap. You can also ask for a booster of Pneumovax to be booked for 2 months after the Prevnar. Prevnar is usually given as a one-off, but boosters of Pneumovax are usually advised every 5 years - at least till the age of 65. (I realise that you are over 65, and at this age the benefits of Pneumovax become more uncertain, but some doctors are happy to give to give them anyway)

This is what I wrote in the vaccination post that CLLerinOz kindly mentioned earlier.

"2) TWO Pneumonia vaccines – first Prevnar 13 (PCV 13), then at least 2 months later – Pneumovax 23 (PPV 23 - also known as PPSV23). Prevnar 20 may now be offered instead of Prevnar13.

healthunlocked.com/cllsuppo...

If your GP questions this, suggest that they check in "The Green Book" for the latest on Pneumococcal vaccinations. (The Green Book is the place for health workers to check for vaccinations recommended in the UK. )

For people with CLL, no vaccinations are going to work as well as for "healthy" people, but it's very unpredictable due to the different stages of disease people are at. Pneumonia is the biggest killer of CLL patients so it's well worth trying to get all the protection from vaccinations, that we can.

Paula

P.S. Here's a link to the chapter in “The Green Book” for Pneumococcal vaccinations. assets.publishing.service.g...

Scroll down to Chapter 25, page 8, third paragraph. See the section :

"Children aged 10 years onwards and adults diagnosed with at-risk conditions. Individuals diagnosed (or first presenting as) from ten years of age should receive a single dose of PPV23, regardless of prior PCV vaccination. No additional PPV23 is recommended when they reach 65 years of age. Older children and adults who are severely immunocompromised2 should be offered a single dose of PCV13 followed by PPV23 at least two months later (irrespective of their previous pneumococcal vaccinations). If PPV23 has already been administered, then wait at least six months after the PPV23 dose to give PCV13 in order to reduce the theoretical risk of pneumococcal serotype-specific hypo-responsiveness."

[shornoff in reply to PaulaS]

Thank you. That was extremely helpful.

[AussieNeil Administrator in reply to PaulaS]

Great response Paula. RZ8983DV , please note that Paula's reply above is also relevant to you. If you look through replies to the pinned post Paula maintains, sadly you'll find that in the UK, this lack of awareness of the need for a Prevnar vaccination/booster is common. Too many members have had to direct GPs to "The Green Book" and/or obtain a recommendation from their consultant to get access to what could be a life saving vaccination booster. This happens because some GPs don't get to see many CLL patients in their career and don't check for updates to "The Green Book". An Australian study found that on average, GPs saw perhaps half a dozen lymphoma cases in their entire career, so that this happens is understandable, but still frustrating!

Neil

[AnneHill]

Yes. We should have a booster every 5 years. My doctors wanted a letter from my consultant confirming this. The hospital did this and confirmed I was to have this every 5 years. I hope you get sorted out ok, Anne uk

[CycleWonder]

Thank you for this information. I will be due for an update this year!

[PaulaS Volunteer]

Although “The Green Book” is very clear about the need for Prevnar 13 (PCV13) as well as Pneumovax 23 (PPV23), it’s not so clear about 5 year boosters of Pneumovax23. assets.publishing.service.g...

Scroll down to Ch 25, page7, 2nd paragraph

"PPV23 Antibody levels are likely to decline rapidly in individuals with no spleen, splenic dysfunction or chronic renal disease (Giebink et al., 1981; Rytel et al., 1986) and therefore re-immunisation with PPV23 is recommended every five years in these groups. Revaccination is well tolerated (Jackson et al., 1999).

Testing of antibody levels prior to vaccination is not required. Although there is evidence of a decline in protection with time (Shapiro et al., 1991), there are no studies showing additional protection from boosting individuals with other indications, including age, and therefore routine revaccination is not currently recommended."

CLL patients are not mentioned there, but we often DO have swollen spleens, that cause splenic dysfunction.

In the US, five yearly Pneumovax boosters are definitely recommended for leukaemia patients. This diagram is helpful.

imgur.com/a/O2GpEyo

Things are changing all the time though. (eg A new version of Prevnar – Prevnar 20, is now available in the States and in some parts of Europe).

Sorry it’s so complicated, shornoff and RZ8983DV . Immunology is a very complex subject - new things are being discovered all the time, and protocols change accordingly.

But I'm certainly going to ask for a 5 year booster for Pneumovax23 - as I too am due another one.

Paula

P.S. I would be asking for a 5 year booster even if I DID have a spleen (though sadly mine ruptured and was removed 7 years ago).