DEAR DR. ROACH: My doctor recommended both pneumococcal vaccines for me. He recommended the PCV-13 (Prevnar) first, followed two months later by the PPSV-23 (Pneumovax). He also told me that if I had them in the reverse order, I would have had to wait a full year between the shots, not just two months. Why is that? — R.S.
ANSWER: I’m afraid the recommendations are a bit confusing.
Not everyone is recommended to have the PCV-13 (Prevnar) vaccine now. Since 2000, when the vaccine began being given routinely to children, the amount of disease caused by the strains of the bacteria covered by the vaccine has drastically reduced, showing that children were carrying the bacteria that led to older adults getting sick. Consequently, there’s less of a benefit of giving the vaccine than there used to be. People with high-risk conditions — say, an immunocompromising condition, spinal fluid leak or cochlear implant — definitely should get the vaccine; otherwise, you and your doctor should discuss whether it’s needed for you.
The PPSV-23 (Pneumovax) is recommended for everyone at 65, and for younger people with a variety of medical conditions, including sickle cell disease, kidney failure and many cancers in addition to the indications for the PCV-13. A person who got it at a young age should get a second dose at age 65, at least five years after the first dose.
As your doctor correctly said, people who get both should get the PCV-13 first, then the PPSV-23. Generally healthy people are recommended to get the PPSV-23 a year after the PCV-13. Giving the two vaccines a year apart leads to higher levels of antibodies, based on clinical studies. However, people with medical conditions requiring both vaccines should get the PPSV-23 eight weeks after the PCV-13, because we want them protected sooner, and that particular order still leads to good levels of antibodies of the strains of pneumococcus that are in both vaccines.
DEAR DR. ROACH: Is it OK to get a COVID vaccine if you currently have COVID? — J.G.
ANSWER: You can get the COVID-19 vaccine after recovering from the acute illness, if you had symptoms, and when you have been told you can discontinue isolation. This generally means at least 10 days have passed since the onset of symptoms, you are more than 24 hours without fever and without taking fever-reducing medicines and any other symptoms you may have had are improved. People with severe immunodeficiency should consult with an infectious disease expert before ending home isolation.
If you were treated with monoclonal antibodies, you need to wait 90 days before getting the vaccine. Many people are eligible to receive the monoclonal antibody treatment for COVID-19, and studies show it reduces symptomatic and severe COVID-19 infection from 23% to 9%. Talk to your doctor as soon as you are diagnosed to see if you are eligible for this important treatment. The currently available antibody treatments (casirivimab/imdevimab and sotrovimab) seem to be active against the newer variants of the virus, such as delta.
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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 or send mail to 628 Virginia Dr., Orlando, FL 32803.
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