Patient education: Pneumonia prevention in adults (Beyond the Basics)
- Daniel M Musher, MD
Daniel M Musher, MD
- Professor of Medicine, Professor of Molecular Virology and Microbiology
- Baylor College of Medicine
The most commonly identified cause of pneumonia leading to hospitalization in the United States is the bacterium Streptococcus pneumoniae, also called pneumococcus. Pneumococcal vaccine is the best way to prevent infection with pneumococcus. Vaccination reduces the number of cases that occur and makes disease less severe when it does occur. Influenza vaccine can also help to prevent pneumococcal pneumonia or pneumonia caused by other bacteria, which can happen as a complication of the flu. (See "Patient education: Influenza prevention (Beyond the Basics)".)
This topic discusses the potential benefits of the pneumococcal vaccines and who should receive them. Symptoms and treatment of pneumonia are discussed separately. (See "Patient education: Pneumonia in adults (Beyond the Basics)".)
There are many different types of pneumococci. Pneumococcal vaccines protect against the most common types by reducing the number of cases that occur and also by reducing the severity of infection when it does occur.
Kinds of pneumococcal vaccines — Two kinds of pneumococcal vaccine are available in the United States, PPSV23 (pneumococcal polysaccharide vaccine 23), which protects against 23 pneumococcal types, and PCV13 (pneumococcal conjugate vaccine 13), which protects against only 13 of these types but may be preferable to PPSV23 in some individuals:
●PPSV23 is recommended for all people over age 2 years who are at increased risk for pneumonia and for everyone 65 years old or older.
●PCV13 is recommended for all infants, for young children who missed receiving it earlier in life, and for adults with a weakened immune system or certain other risk factors for pneumonia, including being 65 years of age or older. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)".)
Who needs vaccination? — Vaccination needs vary by age and other factors (table 1):
Adults with any of the following risk factors should receive both PCV13 and PPSV23:
●Age 65 years or older
●Cerebrospinal fluid leak
●Poor function of the spleen (which includes surgical removal of the spleen, sickle cell disease, or another hemoglobin disorder that damages the spleen)
●Chronic kidney failure
●Lymphoma, including Hodgkin disease
●Metastatic (generalized) cancer
●Drugs that suppress immunity (including prednisone or other glucocorticoids)
●All immunodeficiency states
For the people described above who need both PCV13 and PPSV23, the timing of the two vaccines depends on age, risk factors, and prior vaccination (table 2). When possible, PCV13 should be given first, followed by PPSV23.
Adults aged 19 to 64 years who are cigarette smokers or who have one of the following conditions should receive PPSV23 alone:
●Chronic heart disease, such as congestive heart failure or cardiomyopathy (an enlarged heart), but not just high blood pressure
●Chronic lung disease
●Chronic liver disease or cirrhosis of the liver
Anyone who develops pneumococcal pneumonia and who has not been vaccinated previously should be vaccinated with PPSV23; infection with one strain of pneumococcus does not protect against infection with other strains.
Who needs revaccination? — Adults over 65 years who received PPSV23 before age 65 should receive a one-time revaccination with PPSV23 at least five years after their previous dose of the vaccine.
Adults age 19 to 64 who have previously received PPSV23 alone or at least eight weeks after vaccination with PCV13 for certain conditions (eg, immunocompromise, lack of spleen) should receive a single revaccination with PPSV23 at least five years after the initial vaccination with PPSV23.
Revaccination with PCV13 is not recommended.
Both pneumococcal vaccines are safe to have during pregnancy.
Other vaccines — Yearly vaccination against influenza (the influenza vaccine or the "flu shot" or "flu vaccine") is recommended for all people who are at least six months of age. This vaccine is especially important for those who are at high risk for pneumonia because pneumonia is the most common serious complication of the flu.
The flu vaccine changes from year to year and is most likely to protect you if you get it as soon as it becomes available (usually by October in the northern hemisphere and May in the southern hemisphere). Nevertheless, it can still protect you if you get it later in the season and at any time during the influenza season (usually between October and April in the United States). (See "Patient education: Influenza prevention (Beyond the Basics)".)
Benefits — The pneumococcal vaccine prevents many cases of pneumonia and lessens the severity of pneumonia when it does occur. Likewise, the flu vaccine prevents many cases of influenza and lessens the severity of disease when it does occur. The flu vaccine also reduces the frequency of all bacterial pneumonias, including those caused by various types of bacteria, such as pneumococcus, Staphylococcus, and streptococci. Getting the flu vaccine each year and being up to date in recommendations for pneumococcal vaccine will not prevent all pneumonias but will provide the best known protection. If you are at high risk for either pneumonia or influenza, ask your healthcare provider about the benefits of vaccination for you.
Influenza is a highly contagious disease, whereas the spread of pneumococcus is far less likely and less predictable. Infection control measures can help to prevent the spread of any type of infection, including pneumonia. Infection control is most commonly practiced in healthcare settings but is useful in the community as well. Frequent hand washing with soap and water or alcohol-based hand rubs can be effective, especially after contact with toddlers or young children who appear to have respiratory infections.
Because pneumonia is spread by contact with infected respiratory secretions, people with pneumonia should limit face-to-face contact with uninfected family and friends. They should also cover their mouth and nose when coughing or sneezing, and dispose of tissues immediately. Sneezing or coughing into the sleeve of one's clothing (at the inner elbow) is another means of containing sprays of saliva and secretions and has the advantage of not contaminating the hands.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Adult respiratory distress syndrome (The Basics)
Patient education: Chronic bronchitis (The Basics)
Patient education: Pneumocystis pneumonia (PCP) (The Basics)
Patient education: Chronic granulomatous disease (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Pneumococcal vaccination in adults
Pneumococcal immunization in HIV-infected adults
Approach to immunizations in healthy adults
Assessing the immunologic response to vaccination
Immunizations during pregnancy
Immunizations in hematopoietic cell transplant candidates and recipients
Immunizations for patients with chronic liver disease
Immunizations in HIV-infected patients
Immunizations in patients with cancer
Immunizations in solid organ transplant candidates and recipients
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/ency/article/000145.htm, available in Spanish)
●National Institute of Allergy and Infectious Diseases
●American Lung Association
(www.lungusa.org, click on "Diseases A to Z", then click on "P")
●Canadian Lung Association
- Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2013; :CD000422.
- Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012; 61:816.
- Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep 2010; 59:1102.
- Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014; 63:822.
- Kobayashi M, Bennett NM, Gierke R, et al. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2015; 64:944.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.