Pneumonia vaccines

[Mother1943]

hello all

My question is about the Pneumovax-23 and Prevnar 13.

I got the Prevnar 13 in 2015

The Pneumovax-23 in 2015 as well.

Is it time to get these again? I live in the US.

On W/W for over 20 years. Having immune globulin infusions for the last 5 years or so.

Thank you for any insight.

[SofiaDeo]

Pneumovax-23 wasn't available in 2015, so please check with your doc to see exactly what you had. There's posts with the schedules, just Search for them, or look at the CDC website for normal immunity folks' minimum recommendations.

If it were me, I would be asking to check my T-cell levels before getting any vaccines, and discussing results with my doc. Since the ability to make antibodies is compromised as evidenced by the need for immune globulin infusions, if one had very low T cells, one may not want to risk any potential vaccine side effects. If your body isn't making much of *anything* along those lines, the risk of side effects (based on your history pre & post CLL diagnosis) may slant the decision towards "don't get them".

I am basing this on vaccine recommendations for HIV patients, a different but also immune compromised disease state. Not all immune compromised people with that disease are automatically recommended to get every vaccine. It depends on the patient & their risk factors. For example, with the Pneumovax 23, the initial dose is recommended, the followup one may not be indicated.

hivguidelines.org/guideline...

[SeymourB in reply to SofiaDeo]

SofiaDeo -

Which T-cell level test are you refering to? A specific test for pneumonia T-cells, or CD3, CD4, and CD8 T-cell counts via flow cytometry, or something else?

Also, HIV is an infection of T-cells, so the T-cell levels are skewed differently than CLL tends to be in Watch and Wait.

=seymour=

[SofiaDeo in reply to SeymourB]

Standard CD4 and CD8 T cell testing, as a measure of overall immunity. CD3 (natural killer cell) is a separate test. Someone with somewhat competent neutrophils and immune globulins and macrophages can possibly have problems with T or other cells as the basis for problems with serial infection. Which is why I suggested possibly looking at T cells, since that subset isn't specified in a routine CBC with differential. But in the US at least, it's an easy to order add on, as is CD3/Natural Killer cell.

my.clevelandclinic.org/heal...

mountsinai.org/health-libra...

Labcorp (and probably others) in the US offers a combined CD4+, CD8+, and CD3+ test:

labcorp.com/tests/502500/na...

I don't know what "pneumonia" T cells are. Both bacteria and viruses will affect CD4+ levels, which then (along with other cells) can affect CD8+.

There are a number of diseases of T-cells besides HIV. I am aware of the mechanism of action of HIV disease, having worked in hospitals during the early days of AIDS. The virus is specific to CD4+ cells, but like many diseases of immunity, other cells (like CD8+) also are commonly affected. If specific pneumonias are associated with specific defects or ratios of the various T cells, I haven't worked with docs using these ratios and can't comment on what they might mean. I just used HIV as an example of a disease where T cells are routinely monitored, such that T cell testing is easy to access.

There's even a T cell test out in the US, that tests for previous Covid infection. If someone suspects they are infected but asymptomatic, this could work if one isn't confident in their standard Covid testing.

medicalxpress.com/news/2021...

[SeymourB in reply to SofiaDeo]

SofiaDeo -

I like the full Lymphocyte Suvser tests that report CD3, CD4, and CD8 fir T-cells, CD16 and CD56 for NK cells, and CD19 for B-cells. V&O can completely wiped out CD19 cells, and it can last fie some time after treatment if you achieve U-MRD4.

It'd be great uf we could get vaccine specific T-cell testing. I did the T-Detect from Adaptive during the pandemic. It's only qualitative (positive/negative) and not quantitative. It's no longer offered.

=seymour=

[Mother1943 in reply to SofiaDeo]

Thank you

[Mother1943 in reply to SofiaDeo]

will recheck with pcp. Thank you

[CLLerinOz Administrator]

Hi Mother1943

General advice can be found in our pinned post about Vaccinations: healthunlocked.com/cllsuppo... and CDC advice for those in the US can be found here: cdc.gov/vaccines/vpd/pneumo...

It contains information specifically for the immunocompromised and provides recommendations according to your vaccination history and your age.

In the US, ACIP has recently made recommendations for a new PCV21 vaccine:

healthunlocked.com/cllsuppo...

Especially as you're receiving immunoglobulin infusions it would be a good idea to have a discussion with your specialist about how to proceed.

CLLerinOz

[Mother1943 in reply to CLLerinOz]

Thank you

[Mother1943 in reply to CLLerinOz]

Will check with my oncologist. Thank you

[lankisterguy Volunteer]

Hi Mother1943,

There are new pneumonia vaccines called PCV 20 & PCV 21 that is recommended for adults, especially immune compromised. The chart attached summarizes the timing from this CDC site:

cdc.gov/vaccines/vpd/pneumo...

and mentioned in this CLL Society summary:

cllsociety.org/2022/03/vacc...

as well as our excellent Pinned Post by CLLerinOz here: healthunlocked.com/cllsuppo...

Len

Pneumonia Vaccine

[Mother1943 in reply to lankisterguy]

Will check out those sites. Thank you