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
- Section Editors
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
- Julio A Ramirez, MD, FACP
Julio A Ramirez, MD, FACP
- Section Editor — Pulmonary Infections
- Professor of Medicine
- University of Louisville
Pneumonia is a common illness that can be serious or even life-threatening. Not all cases of pneumonia can be prevented, but taking certain measures can help. To help prevent pneumonia, you should:
●Wash your hands
●Lead a healthy lifestyle, including eating a healthy diet and exercising regularly
This topic reviews the benefits of pneumonia vaccines, who should receive them, and other ways to help prevent pneumonia. Information on the symptoms and treatment of pneumonia is provided separately. (See "Patient education: Pneumonia in adults (Beyond the Basics)".)
Pneumonia can be caused by a number of different bacteria, viruses, or other infecting organisms (germs). Vaccines that protect against two major causes of pneumonia are available: pneumococcal vaccines and influenza vaccines. Vaccines that protect against some of the less common causes of pneumonia, such as the pertussis vaccine, are also available. When appropriate, getting vaccinated and encouraging others around you to do the same are the best ways to prevent pneumonia.
Pneumococcal vaccines — Pneumococcal vaccines provide protection against pneumococcus (also known as Streptococcus pneumoniae), which is one of the most common bacterial causes of pneumonia in adults.
There are many different types of pneumococci. Pneumococcal vaccines protect against the most common types by stimulating the production of antibodies (proteins that the immune system makes) that help to fight off infection. Vaccination reduces the number of people who get pneumonia and makes disease less severe in those who do get it.
Types of pneumococcal vaccines — Two kinds of pneumococcal vaccine are available in the United States. These vaccines have different properties that make them appropriate for different populations:
●PPSV23 (pneumococcal polysaccharide vaccine) is generally used in adults and protects against 23 types of pneumococcus. PPSV23 is not effective in infants and children under two years old.
●PCV13 (pneumococcal conjugate vaccine) was developed for use in infants and children. It protects against 13 types of pneumococcus. Because PCV13 stimulates a protective immune response in both adults and children, PCV13 is given in addition to PPSV23 in adults who are at high risk for serious pneumococcal infection (see below).
Who needs vaccination? — Vaccination is particularly important for adults who are 65 or older, smokers, people with weakened immune systems, and people who have certain chronic illnesses. Specific vaccination recommendations vary by age and other factors. Your doctor or nurse can talk to you about what is most appropriate for your situation.
●Vaccination with PPSV23 is recommended for all adults 65 years or older and any adult (over the age of 18) who smokes or has one or more of the following chronic illnesses:
•Chronic heart disease, including congestive heart failure and cardiomyopathy (but not including high blood pressure)
•Chronic lung disease, including asthma and chronic obstructive pulmonary disease (COPD)
•Chronic liver disease
●Vaccination with both PCV13 and PPSV23 is recommended for all adults who are at high risk for serious pneumococcal infection. People considered high risk include those with one more of the following conditions:
•Age 65 years older with one or more of the chronic illnesses outlined above or active smoking
•Cerebrospinal fluid leak
•Poor function of the spleen (this includes people who have had their spleen removed and those with sickle cell disease or another disorder that causes spleen damage)
•Chronic kidney failure
•Lymphoma, including Hodgkin disease
•Metastatic cancer (cancer that has spread beyond the original location)
•An immune system that is weaker than normal, such as with congenital or acquired immunodeficiencies or the use of immunosuppressive medications (including long-term steroid use and radiation therapy)
Vaccination with both PCV13 and PPSV23 is also reasonable for any adult 65 years or older and people with a history of invasive pneumococcal infection, such as meningitis or a bloodstream infection.
When both vaccines are needed, PCV13 should be given first. PPSV23 is typically given about eight weeks after PCV13, except in adults 65 and older who have none of the chronic illnesses or high-risk conditions outlined above. For these patients, a one-year interval between PCV13 and PPSV23 is advised. If PPSV23 has already been given, waiting one year before giving PCV13 is advised.
Both pneumococcal vaccines are safe for pregnant women.
Who needs revaccination — Adults under 65 years old with poor spleen function or those with other conditions that affect the immune system should receive a second dose of the PPSV23 vaccine about five years after the first dose. Revaccination with PCV13 is not recommended.
Influenza vaccines — Influenza (flu) vaccine reduces the risk of pneumonia caused by the influenza virus. They can also help to prevent pneumococcal pneumonia or pneumonia caused by other bacteria, which can occur as a complication of influenza. Yearly influenza vaccine (the "flu shot") is recommended for everyone over the age of six months. This vaccine is especially important for those who are at high risk for pneumonia; this is 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)".)
Other vaccines — Vaccines that protect against less common causes of pneumonia include vaccines for pertussis (whooping cough), Haemophilus influenza type B (Hib), measles, and varicella (chickenpox). Ensuring that you and those around you are up to date on recommended vaccines can help prevent pneumonia in you, your family, and your community. The exact recommended schedule for vaccinations varies by age. (See "Patient education: Vaccines for adults (The Basics)" and "Patient education: Vaccines for babies and children age 0 to 6 years (The Basics)" and "Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)".)
Smoking weakens your resistance to pneumonia by causing damage to your lungs. Quitting smoking and avoiding secondhand smoke exposure is another important way to help prevent pneumonia and improve your overall health. (See "Patient education: Quitting smoking (The Basics)" and "Patient education: Quitting smoking (Beyond the Basics)".)
Washing your hands with soap and water or using an alcohol-based hand sanitizer is one of the most important ways to avoid getting sick and spreading illness to others, particular when you have a viral infection such as influenza. Because pneumonia is spread by contact with infected respiratory secretions (tiny droplets that can travel through the air), exposure to someone who has pneumonia increases the risk for infection. People who have pneumonia should cover their mouths and nose when coughing or sneezing, dispose of used tissues immediately, and wash their hands. Sneezing or coughing into the sleeve of one's clothing (at the inner elbow) is another way to keep saliva and secretions from spreading to others; it also has the advantage of keeping the hands clean.
Living a healthy lifestyle including eating right, exercising, and maintaining a healthy weight can help prevent many health problems. Taking medicines as prescribed, particularly for chronic illnesses that increase the risk of pneumonia, can also help prevent health complications. (See "Patient education: Diet and health (Beyond the Basics)" and "Patient education: Preventive healthcare for older adults (The Basics)".)
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.
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 adults 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
●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.