Winter Health Check-Up

Your risk of contracting pneumococcal pneumonia increases in winter and spring – learn more about how to help protect yourself

A 66-year old woman goes to the doctor because she feels unwell, coughing, with uncharacteristically low energy.

It’s cold and flu season. Could it be a cold, an upper respiratory infection?

Or could it be pneumococcal pneumonia? She doesn’t have the classic symptoms as described by Dr. Samir Sinha, Director of Geriatrics at Sinai Health System and the University Health Network: “fever, chest pain, chills, coughing, and trouble breathing.”

“Sometimes older adults who have pneumonia may not have the classic symptoms,” says Dr. Sinha. “They just feel unwell, with low energy.”

With age, the immune system weakens, which can increase the risk of getting infectious diseases. Pneumococcal pneumonia, a bacterial infection transmitted like the flu through respiratory droplets in the air, can be dangerous for adults 65 and over.

An exam and tests establish that, just as her doctor suspected, the woman indeed has pneumococcal pneumonia, the most common variant of the bacterial pneumonia.

She’s prescribed a course of antibiotics and is able to recover slowly at home over a period of weeks, getting back to her regular activities after a month or so.

“Some people, especially in high-risk groups like those with chronic lung disease, may experience complications and need to be hospitalized,” says Dr. Sinha. “If they have difficulty breathing, they may even require the use of a breathing tube in the most severe cases.”

“As you get older — and especially if you have a chronic condition like diabetes or heart disease — you are more susceptible to pneumococcal pneumonia. And hospitalization could impact your mobility after recovery.”

“Right now, a lot of people underestimate how dangerous pneumococcal pneumonia can be,” warns Dr. Sinha. “If people understood the disease better, they’d understand how important it is to help protect themselves against it.”

Pneumococcus bacteria, or streptococcus pneumoniae, can cause a number of infections including community acquired pneumonia, and some cases can be severe.  In fact, pneumonia is a potentially deadly  lung infection that’s among the top ten reasons for emergency department visits in Canada with 135,000 visits due to pneumonia in 2017-2018. Older adults made up approximately 65 per cent of pneumonia-related visits for admitted patients last year, according to the Canadian Institute for Health Information. Pneumococcal pneumonia is the most common form of bacterial pneumonia.

“We want to see 80 per cent of older adults vaccinated against pneumococcal pneumonia,” he says. But according to a 2016 survey, only 42 per cent of adults 65-years-old and over reported receiving a pneumococcal vaccine.

And, he adds, “It’s at both extremes of the age spectrum when the immune system is weakest.”

He explains, “As we get older, there are two things that can happen. The immune system weakens with time — we call it ‘immune senescence’ — and as you get more mileage, you can encounter heart disease and diabetes that increase the risk of pneumococcal pneumonia.”

That’s why, he says, “Depending on your age and stage of life and state of health, we will recommend one or both pneumococcal vaccines.”

Canada’s National Advisory Committee on Immunization (NACI) recommends that all Canadians 65+ should be given Pneumovax 23 vaccine as part of a routine immunization program to help protect themselves against pneumococcal disease. On an individual basis, for adults 65 and over who have not been previously vaccinated, if immunization with Prevnar 13 is being considered, Prevnar 13 is given first, followed by Pneumovax 23. For immunocompromised individuals, NACI recommends immunization with Prevnar 13 vaccine followed by Pneumovax 23. Pneumovax 23 protects against the following types of pneumococcus bacteria: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F. Prevnar 13 protects against the following types of pneumococcus bacteria: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F.11 Individuals should speak to their doctor, pharmacist or nurse to understand what would be best for them.

“Every single person 65 and over, even if they’re healthy and independent, would be better off helping protect themselves against pneumococcal pneumonia,” Dr. Sinha says.

Discussing with your health provider which vaccines are suitable or recommended to help protect against flu, shingles, tetanus and pneumonia, is a must for every older Canadian, advises Dr. Sinha.


Vaccination does not protect 100% of those who are vaccinated.

Prevnar® 13 is not indicated to reduce complications of pneumococcal pneumonia, such as hospitalization. The need for revaccination with a subsequent dose of Prevnar 13 has not been established. Prevnar 13 is a vaccine used for the prevention of diseases such as pneumonia, bacteraemic pneumonia, sepsis and meningitis caused by 13 types of the bacteria Streptococcus pneumoniae. Serious warnings and precautions: Take special care with Prevnar 13 if you have any present or past medical problems after any dose of PREVNAR (7-valent) or Prevnar 13, if you are sick with a high fever or if you have any bleeding problems. Prevnar 13 will only protect against disease caused by the types of S. pneumoniae covered by the vaccine. Prevnar 13 will not protect 100% of people who receive the vaccine. Prevnar 13 should not be used in anyone who is allergic (hypersensitive) to the active substances, to any other ingredients, or to any other vaccine that contains diphtheria toxoid. The most common side effects (reported in at least 1 in 10 adults) are decreased appetite, headache, diarrhea, rash, new joint pain/aggravated joint pain, new muscle pain/aggravated muscle pain, chills, fatigue, any pain, tenderness, redness, swelling or hardness at the injection site, and/or limitation of arm movement. Other common side effects (reported in less than 1 in 10 adults) were vomiting and fever. This is not a complete list of side effects. For any unexpected effects while taking Prevnar 13, contact your doctor or pharmacist.