Greg Poland, MD, on Zoster, Pneumococcal Vaccines


Dr Gregory Poland, from Mayo Clinic, Rochester, speaks about zoster vaccination in older adults, how it will affect them later on, and the contraindications for the vaccine.

Gregory Poland, MD, is a professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minnesota, director of the Mayo vaccine research group, and editor in chief of Vaccine



Dr. Greg Poland:  Hello, everybody. My name is Dr. Greg Poland. I'm a professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minnesota. I'm the director of the Mayo Vaccine Research Group and the editor‑in‑chief of the journal "Vaccine."

We will talk today about immunizations in older adults. I don't think there's anybody listening to this podcast that has not seen a patient with zoster. Likely, a number of people listening have themselves had zoster shingles.

Prevention of it is important. Not only because of the disease but because of the complications, and probably primary among those that we do see is postherpetic neuralgia. This one is particularly poignant for me because as a young medical resident, one of my patients who had postherpetic neuralgia took her own life. A good reflection of the relatively poor pain treatment protocols we had way back then, but it's a reason to prevent this disease.

We have two vaccines licensed in the US ‑‑ a zoster vaccine that is a live‑attenuated, and then the newest approved and licensed vaccine which is a two‑dose subunit‑adjuvanted vaccine.

The advantage of the latter is superior immunogenicity and superior durability of that immune response. It is the preferred drug as listed by the ACIP, the Advisory Committee on Immunization Practices.

There really is not any contraindication to the inactivated subunit‑adjuvanted vaccine. There is with the live‑attenuated viral vaccine. We wouldn't want to give that to somebody who is immunocompromised or who was taking any drugs that would cause any immunosuppression.

Short of that, you'll see sometimes things in the literature about maybe not giving concomitant influenza or pneumococcal vaccine. But I don't think there's any convincing data to suggest that immunogenicity or efficacy is less. In fact, there's every reason ‑‑ when we have our big yearly influenza vaccine campaigns ‑‑ to think about whether they've gotten zoster vaccine, whether they've gotten acellular pertussis vaccine. The other big one for older adults are pneumococcal vaccines.

Both the polysaccharide and the protein‑conjugate vaccine are vaccines designed to prevent various numbers of strains or types of pneumococcal disease. A common time to see pneumococcal disease is during the respiratory virus season, and it's a common complication of influenza. These are vaccines that should be given routinely.

There are two vaccines as I mentioned. The PCV13, this is a conjugate vaccine that induces immune memory, and the polysaccharide or PPSV23 vaccine which does not induce immunologic memory, but we standardly use both of them.


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