Do I Really Need Pneumonia and Tdap Vaccines?
Q. I am a 66 year-old man who was recently discharged from the hospital after a prolonged and resistant pneumonia. After seeing an allergy/immunology doctor for an evaluation of a possible immune deficiency problem, I had some lab studies done. A certain test called gamma globulin came back in the low normal range but some of the other tests were not quite normal. The allergist recommended that I have a Pneumovax (pneumococcal vaccine) and a tetanus/diptheria/pertussis vaccination and then have some repeat blood tests. Is it really necessary to have both of these vaccines and how do they help to identify if I have an immune problem?
A. Someone with an immune deficiency is very likely to have low normal or even normal gamma globulin levels but still have an inability to make antibodies to specific organisms, such as pneumococcus, a bacteria which can cause pneumonia. The blood work you had taken likely showed your allergist that you lacked proper antibodies to specifically fight pneumococcal diseases and that you lacked protection against tetanus and/or diphtheria. The absence of these antibodies does not in itself mean that you have an immune problem as you may have lost the immunity from the diphtheria/tetanus/pertussis that you had as a child and likewise, may indicate that you have not been exposed to many of the pneumococcal organisms that were tested in the blood. However, you need protection against all these organisms - a recommendation for all adults over 65!
By receiving the vaccines that your physician has recommended, you will likely gain that protection. And by repeating the blood tests in 4 weeks following the vaccinations, your allergist will know if your immune system is functioning properly. You really need both vaccinations for protection and to gain necessary information about your immune system. If there is an inadequate response to these vaccines, further immune studies and treatment, possibly long-term, may be required. These vaccines can be administered at the same time. In terms of cost, Medicare will cover the cost of the blood tests and the Pneumovax but will likely not cover the cost of the Tdap at this time (but that might change soon). I would suggest that you follow your allergist’s advice and obtain the vaccines and then the blood tests 4 weeks later.