The forgotten crisis

WASHINGTON -- The flu-shot shortage makes it more imperative for elderly Americans to get a second, often overlooked vaccine that protects against a type of pneumonia germ that's a common complication of influenza.

Called pneumococcal vaccine, it's a one-time shot for anyone 65 or older. Younger people with heart and lung diseases, diabetes or weak immune systems need it, too.

It's not a replacement for a flu shot; high-risk patients should continue trying to find that.

But many of the same people most vulnerable to flu also are at high risk from this dangerous bacterial infection. They need the pneumococcal vaccine anyway -- and this fall marks a good time to go ahead and get it, especially if they can't find a flu shot.

"Absolutely," says Dr. Gregory Poland of the Mayo Clinic, who advises the government on pneumococcal vaccine. "It's a good backup to prevent the complications of influenza."

Despite its name, the pneumococcal vaccine protects against more than pneumonia. It prevents deadly blood infections and meningitis, too, caused by a bacterium called pneumococcus.

It's a scary germ, because it causes so much damage so rapidly.

Poland describes a seemingly healthy grandmother who one day felt a little achy and feverish. The next day, she was rushed to the hospital -- and doctors watched in horror as jet-black, gangrenous streaks gradually formed on her limbs. The germs had infected the woman's bloodstream.

"To save her, they would have to cut away parts of her," Poland recalls.

Her hands and feet amputated, she now uses a wheelchair.

Federal data show that each year, 175,000 Americans are hospitalized with pneumococcal-caused pneumonia. In addition, the germ causes more than 50,000 blood infections and up to 6,000 cases of meningitis. Almost 6,000 die.

A childhood vaccine, called Prevnar, has proved very effective at battling seven pneumococcal strains common in babies and toddlers.

But millions of adults are at high risk from additional strains of the germ and thus need the adult version of the vaccine, according to the Centers for Disease Control and Prevention. Those on the CDC list include:

• Everyone 65 and older.
• Anyone with diabetes, heart disease, chronic lung disease except asthma, chronic liver disease or kidney failure.
• Anyone with weakened immune systems from cancer, HIV or organ transplants.
• People without a functioning spleen or who have sickle cell disease.
• Residents of long-term care facilities.

Every fall, the CDC issues a call for those people to get the vaccine, called Pneumovax -- a call this year overshadowed by the flu-shot crisis.

The government hopes to have 90 percent of the elderly vaccinated against pneumococcal disease by 2010, but just 63 percent are now. Even fewer of the younger high-risk patients are thought to be protected.

"Both the public and, unfortunately, health-care workers are inadequately informed," Poland laments. "They simply do not know this vaccine is available."

Medicare pays for the shot; for younger patients, cost ranges from $30 to $50. The good news: There's no shortage of Pneumovax, Poland says, although there is only one supplier, Merck & Co.

While one shot lasts the elderly a lifetime, anyone under 65 when they get the adult vaccination needs a booster after five years.

Stay tuned: Health officials are considering expanding the number of people who should get vaccinated to anyone 50 or older. That's the age when the risk of invasive pneumococcal disease begins to rise, before a more dramatic surge in the 60s, explains Poland, who is heading a CDC panel debating the change.

For now, if today's toll isn't convincing enough, consider that the germs are rapidly evolving ways to defy antibiotic treatment -- making prevention increasingly important.

"Ignorance isn't bliss," Poland warned. "Sometimes it kills you."