When records and patient memory differ, it’s best to revaccinate

DEAR DR. ROACH: I am a 77-year-old female. I am current on all vaccines, but I do have a question about the pneumococcal vaccine.

My current physician recommends that I get one. I thought that I had gotten that vaccine a few years ago from my physician who retired. We are unable to find in my medical file that it was given. That was also a time when they were switching to all computer access charting. I also got no confirmation from the pharmacy that sometimes gives my vaccines.

My physician recommends I get another one since we have no record or proof of it being administered. Is it safe to get it again if I have had it? I am willing to do so, but I’d like a second opinion. I just completed my Moderna COVID-19 series, so I would get the pneumococcal vaccine in three months. – V.W.

ANSWER: There are two kinds of pneumococcal vaccines. These protect against pneumonia and other serious diseases, such as meningitis and bacteremia, from the bacteria Streptococcus pneumoniae, also called pneumococcus. They are sometimes referred to as pneumonia vaccines, but pneumococcal vaccine is more correct.

I am pretty sure your doctor is recommending the pneumococcal polysaccharide vaccine, which protects against 23 different subtypes of pneumococcus. This one is called PPSV-23, or by its brand name, Pneumovax. The other, the pneumococcal conjugate vaccine, protects against 13 types (PCV-13 or Prevnar). Recently, the Advisory Committee on Immunization Practices, which makes recommendations about vaccine use, downgraded its recommendation about the PCV-13 from universally recommending to all 65-year-olds to instead having a discussion about whether it’s appropriate on an individual basis. Since children have started routinely getting the PCV-13, there is a whole lot less invasive pneumococcal disease of the subtypes protected by the PCV-13.

In your case, the choice is whether to give the PPSV-23 again, possibly for a second time — or not, meaning you might not have ever gotten it. In my mind, the balance of risks is strongly in favor of giving the vaccine. Getting it twice is not harmful. It’s a well-tolerated vaccine, with generally far fewer side effects than the Moderna vaccine you just took. I’ve had patients get it twice with no ill effects.

DEAR DR. ROACH: Can you advise me on using melatonin? I am 69 years old, and I try to do all the normal things to encourage sleep, like avoiding screens and caffeine, and going to bed at the same time each night. I will take a 3 mg tablet and then if it doesn’t work, I will get up an hour later and take another. What do you think? My doctor says it’s OK to take with my medicines. – M.L.C.C.

ANSWER: Melatonin is one of the safest sleep aids available, but, unfortunately, it is ineffective for many people.

Oddly, the use of lower doses often has better results than higher doses. Especially for older adults, I recommend 0.5 to 1 mg doses, which are harder to find than higher doses, but you may be able to split a larger tablet.

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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