Patient information: Pneumonia prevention

INTRODUCTION

The most common cause of pneumonia in the United States is the bacterium Streptococcus pneumoniae, or pneumococcus. The pneumococcal vaccine is the best way to prevent infection with pneumococcus. The influenza vaccine can also help to prevent pneumonia, which can develop as a complication of the flu. (See "Patient information: Influenza prevention".)

This topic discusses the pneumococcal vaccine, including who should be vaccinated and the potential benefit of vaccination. Symptoms and treatment of pneumonia are discussed separately. (See "Patient information: Pneumonia in adults".)

PNEUMONIA VACCINE

The pneumococcal vaccine protects against the most common types of pneumococcal bacteria. Protection against pneumococcus has become more important as difficult to treat strains of pneumococcus have emerged.

Types of vaccine — There are two types of pneumococcal vaccine available in the United States, PPSV23 (pneumococcal polysaccharide vaccine 23) and PCV13 (pneumococcal conjugate vaccine13).

• PCV13 is recommended for children. Four doses are given at age 2, 4, 6, and 12 to 15 months. (See "Patient information: Vaccines for infants and children age 0 to 6 years".)
• PPSV23 is recommended for everyone older than 65 years old, as well as for anyone over age 2 years who is at high-risk for pneumonia.

Who needs vaccination? — Current guidelines recommend giving one dose of the pneumococcal vaccine to everyone aged 65 years or older if they have not previously been vaccinated. For people who were given the vaccine before age 65, a one-time revaccination is recommended after 5 years.

Younger people who are at risk of pneumococcal disease includes people with diabetes mellitus, heart and lung disease, alcoholism, liver disease, cochlear implants, those with a weakened immune system, adults who smoke cigarettes, and people living in special environments (eg, nursing home residents).

Those aged 2 to 64 years who are at risk for pneumonia should be given the vaccine when the need for immunization is recognized. Women who are pregnant or who intend to become pregnant should speak to their healthcare provider about the safety of the vaccine.

Anyone who develops pneumococcal pneumonia who has not been vaccinated previously should be vaccinated; infection with one strain of the bacteria does not necessarily protect the person against infection with other strains.

Need for booster vaccination — The need for a one-time booster vaccine depends up an individual's circumstances.

Other vaccines — Influenza vaccine (the flu shot) is also recommended for people who are at high-risk for pneumonia since pneumonia is a common complication of influenza infection. It is given once per year, usually between October and January in the United States. (See "Patient information: Influenza prevention".)

Benefits — The pneumococcal vaccine cannot prevent all cases of pneumonia. However, evidence suggests that people who are vaccinated against pneumococcal infection and then become infected with the pneumococcal bacteria generally have a milder and shorter infection with fewer serious complications than those who are unvaccinated. Thus, anyone who is at high-risk for either pneumonia or influenza should discuss the benefits of vaccination with their healthcare provider.

INFECTION CONTROL

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.

Because pneumonia is spread by contact with infected respiratory secretions, people with pneumonia should limit face-to-face contact with uninfected family and friends. The mouth and nose should be covered while coughing or sneezing, and tissues should be disposed of immediately. Sneezing/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 every four months 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

Patient information: Influenza prevention
Patient information: Pneumonia in adults
Patient information: Vaccines for infants and children age 0 to 6 years

Professional level information

Approach to immunizations in healthy adults
Assessing the immunologic response to vaccination
Immunization of pregnant women
Immunizations after hematopoietic cell transplantation
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
Impact of universal infant immunization with pneumococcal (Streptococcus pneumoniae) conjugate vaccines in the United States
Pneumococcal vaccination in adults

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

      (www.niaid.nih.gov)

• American Lung Association

      (www.lungusa.org, click on "Diseases A to Z", then click on "P")

• Canadian Lung Association

       (www.lung.ca/pneumonia)

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