ASK THE GP: I’m worried my pneumonia jab has worn off after 20 years

ASK THE GP: I’m worried my pneumonia jab has worn off after 20 years . . . Dr Martin Scurr answers your health questions

When I was 20, I had an extremely bad case of pneumonia. After that, I was very prone to chest infections.

So, around 20 years ago, I had the pneumonia jab.

I am now 73 and my family are very long-lived — so I expect to live into my 90s. What I want to know is: will the pneumonia jab cover me for the rest of my life or should I have another one?

I read that the jab lasts only about 20 to 25 years. I always have the flu jab.

K. Faed, Hoyland, South Yorks.

Thank you for your letter — this is an important issue. There are many different types of pneumonia: some caused by viruses and some by bacteria.

What the vaccine protects against is infection by the pneumococcal bacteria — which don’t only cause pneumococcal pneumonia (inflammation of the lungs), but can also cause meningitis and other serious infections that can lead to brain damage or prove fatal.

The protection that this jab affords is, therefore, absolutely vital.

What the vaccine protects against is infection by the pneumococcal bacteria

That’s why it is recommended for all those aged 65 and over — age is a major risk factor for the infection as the natural defences decline.

Others who are at increased risk of pneumococcal infection are smokers, those with heart or lung disease or diabetes, heavy drinkers and those with cirrhosis of the liver, as people in these categories will also have weakened immune systems.

The jab is also essential for those who have undergone removal of the spleen, because this also plays a role in the immune system, as well as for patients with compromised immunity following an organ transplant or those undergoing chemotherapy for cancer.

The bacteria that cause pneumococcal pneumonia are enclosed in a strong capsule (made of complex sugars) that help it hide from our natural immune defences.

The best advice for drinkers?

In recent weeks, we have been told that two alcoholic drinks a day will result in a longer, healthier life — while now, another report, claiming to be definitive, says that any alcohol at all is bad for you.

Confusing or what? The result is that most people will shrug their shoulders and carry on as before.

Rather than cherry-picking which bit of research to listen to and which to ignore, based on what suits us, the solution is to commit to following the principle of common sense . . . as always, moderation is key.

What the vaccination does is stimulate the production of long-lasting antibodies that attack the bacterial capsule, thereby enabling white blood cells to ingest any of these bacteria, should they invade the body.

There are around 90 different strains of the bacteria, but only a small proportion of these cause the most serious pneumococcal infections: the vaccine for adults triggers the production of antibodies to 23 of those strains that are responsible for 60 per cent of all pneumococcal infections — slightly different to the one-off injection used in children.

This provides protection against 13 different strains. These are the ones more likely to affect children, who have differently developed immune function to adults.

Normally, the adult vaccine is given as a single dose, which is considered sufficient for most — bearing in mind that most will receive this after the age of 65.

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You, however, received the injection more than 20 years ago and, as we know immunological responses do wane in older adults, I think it would be advisable to have a repeat injection, especially given the enduring problems with your chest, which is where the pneumococcal bacteria tend to migrate.

There is some evidence that injection-site reactions — which include redness, swelling and pain — are slightly more common after re-vaccination, but such responses are far less common when more than five years has passed since the previous dose.

In summary: go ahead, speak to your GP about receiving a second dose of the pneumococcal vaccine, which can be given at the same time as your influenza protection, at the beginning of October.

I am writing to you out of concern for my 33-year-old daughter, who has been having severe abdominal pains two or three times a week for several years.

Her GP has sent her for various tests, which have not found anything, and says that it must be down to stress.

A food allergy test found she was allergic to gluten and lactose. Eliminating these brought some relief, but still the pain can occur. She was prescribed omeprazole — but these are ineffective. Would it be beneficial for her to have an appointment with a private consultant?

Name and address supplied.

A worthy prescription

People who’ve had a stroke are an astonishing 70 per cent more likely to develop dementia, according to a new study from the University of Exeter.

The researchers say that this underlines the need for ‘improvements in stroke prevention’. And who could disagree with that? The main risk factor for stroke is, of course, high blood pressure —and I would say that GPs are already pretty fastidious in tackling this, offering lifestyle advice and, inevitably for some, medication.

For those who like to accuse doctors of being too quick to medicate, I would suggest this study goes some way to showing what happens if you don’t.

I share your anxiety for your daughter. My philosophy is that it is a mistake to conclude symptoms are due to stress or depression just because other investigations cannot draw any conclusions.

In a person of 33 with episodic pain — without a change of bowel function, rectal bleeding, vomiting or any other co-existing symptoms — there could be several potential causes.

Gallstones can cause severe bouts of pain called biliary colic, but I would hope this possibility has been excluded by an ultrasound scan. If not, ask your daughter to discuss this with her GP.

Acid-related disease such as a stomach ulcer is less likely, given your description and the fact that an omeprazole, which is acid-suppressant medication, gave your daughter no relief.

Another possibility could be an abnormality dating from birth called Meckel’s diverticulum, in which a hollow sac on the side of the small intestine (a remnant from development when in the womb) becomes infected or ulcerated.

Two per cent of us have these, but symptoms, including bouts of abdominal pain, affect far fewer — and most remain silent.

Write to Dr Scurr

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

Diagnosis involves an ultrasound or CT scan or a laparoscopy (an inspection of the abdomen with a camera under general anaesthetic). Treatment is normally surgery.

I would urge caution about the food allergy diagnosis. In my opinion, that is not a valid hypothesis. Food allergy does not cause abdominal pain.

Your daughter, nevertheless, must undergo the full logical chapter and verse of formal investigations — even if that means a laparoscopy under general anaesthetic.

She should see a consultant gastroenterologist. I would expect this can be accomplished as an NHS patient. It could be a folly to write a blank cheque by venturing down the private path.

In my view… schools must teach cooking

The advice we were given at medical school — although tongue-in-cheek — was that if we wanted a long, healthy life, it was important to have chosen our parents wisely!

It’s a fair point, as it stresses the importance of good genes — but it needs to incorporate the wisdom of Greek doctor, philosopher and scientist Galen, who suggested that a healthy youth is the basis for a robust old age.

This is possibly even more relevant today than when he wrote it some 2,000 years ago.

That means teaching children to cook so that they know how to make a healthy meal, keeping the school gates closed at lunchtime and giving children the opportunity to stay fit

I have twin girls, aged 15, who attend an inner-city comprehensive school here in Glasgow. Their mother, a dietitian, ensures they have a first-rate diet and, at least twice a week, they take in a packed lunch, always containing perfect and welcome choices.

But it grieves me to see that, in order to avoid the rather unappetising lunch provided at school, hundreds of the children dash out instead to feast on high-calorie rubbish from the two or three fast-food shops nearby.

Now, I am alarmed to see that a nationwide branch of a cheap sandwich chain has been granted planning permission to open close to the school gates — a cynical strategy.

My girls take a lot of exercise, but many do not, and, this weekend, an analysis found that the number of hours spent on sports lessons in schools for GCSE pupils has fallen by 21 per cent on average. The key to good health has to be introduced at a young age for it to have maximum impact and there are basics that can be done to go some way to achieving that.

That means teaching children to cook so that they know how to make a healthy meal, keeping the school gates closed at lunchtime — but providing a healthy, nutritious and attractive school lunch — and giving children the opportunity to stay fit and active all the way through their school life.

Too often, I fear, we are missing the opportunity to teach these essentials to those who need to learn them most.

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