Bacterial pneumonia primary prevention: Difference between revisions

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__NOTOC__
__NOTOC__
{{Bacterial pneumonia}}
{{Bacterial pneumonia}}
'''Editor-In-Chief:''' [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [Mailto:charlesmichaelgibson@gmail.com| <nowiki>[1]</nowiki>]; '''Associate Editor(s)-in-Chief:''' Arooj Naz<br />
'''Editor-In-Chief:''' [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [Mailto:charlesmichaelgibson@gmail.com| <nowiki>[1]</nowiki>]; '''Associate Editor(s)-in-Chief:''' [[User:AroojNaz|Arooj Naz, M.B.B.S]]<br />


==Overview==
==Overview==
The goal of ''Primary prevention'' is to prevent the occurrence of an illness or a disease before it ever occurs. In the case of bacterial pneumonia, primary prevention can be achieved by the administration of vaccination as well as attempting to control underlying comorbidities that may predispose an individual to pneumonia. When certain conditions are present, it may also be helpful to treat with prophylactic antibiotics.<ref name="CDC">{{cite web|url=https://www.cdc.gov/pneumococcal/clinicians/prevention.html}} </ref> Educating the public as well as identifying those most susceptible to infection can help reduce the risk of pneumonia.
The goal of [[primary prevention]] is to prevent the occurrence of an illness or a disease before it ever occurs. In the case of [[bacterial pneumonia]], primary prevention can be achieved by the administration of [[vaccination]] as well as attempting to control underlying [[comorbidities]] that may predispose an individual to [[pneumonia]]. Pneumococcus [[Vaccines]] include the PCV13 (Conjugate vaccine) and the PPSV23 (Polysaccharide vaccine). The PCV13 vaccine is indicated in infants and childhood routine vaccines (children younger than 2 years) as well as all adults aged 65 years or older whereas the PPSV23 vaccine is recommended for all adults over the age of 65 as well as adults aged 19-64 with certain medical conditions including [[Chronic heart failure|chronic heart]], [[lung]], or [[liver diseases]], [[diabetes]], [[Smoking|smokers]] and [[Alcoholism|alcoholics]]. The killed intramuscular [[influenza vaccine]] should be given annually. Strict [[blood glucose]] and [[blood pressure]] control can help in preventing disease [[prevalence]]. When certain conditions are present, such as in children that have [[asplenia]], it may also be helpful to treat with [[prophylactic antibiotics]].<ref name="CDC">{{cite web|url=https://www.cdc.gov/pneumococcal/clinicians/prevention.html}} </ref> Educating the public as well as identifying those most susceptible to infection can help reduce the risk of pneumonia.


=Vaccinations=
=Vaccinations=
-Routinely administered vaccines include:
- Routinely administered vaccines include:


*Pneumococcus (Intramuscular Conjugate or  polysaccharide vaccine)
*[[Pneumococcus]] (Intramuscular Conjugate or  polysaccharide vaccine)
*Annual vaccine against H. influenza(Intramusuclar killed vaccine)
*Annual vaccine against [[H. influenza]] (Intramuscular killed vaccine)


{| class="wikitable"
{| class="wikitable"
|+Pneumococcus Vaccine Indications<ref name="pmid27376105">{{cite journal| author=Hayward S, Thompson LA, McEachern A| title=Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ. | journal=J Patient Cent Res Rev | year= 2016 | volume= 3 | issue= 2 | pages= 111-115 | pmid=27376105 | doi=10.17294/2330-0698.1214 | pmc=4927079 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27376105  }}</ref><ref name="pmid30115336">{{cite journal| author=Grief SN, Loza JK| title=Guidelines for the Evaluation and Treatment of Pneumonia. | journal=Prim Care | year= 2018 | volume= 45 | issue= 3 | pages= 485-503 | pmid=30115336 | doi=10.1016/j.pop.2018.04.001 | pmc=7112285 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30115336  }}</ref>
|+Pneumococcus Vaccines<ref name="pmid27376105">{{cite journal| author=Hayward S, Thompson LA, McEachern A| title=Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ. | journal=J Patient Cent Res Rev | year= 2016 | volume= 3 | issue= 2 | pages= 111-115 | pmid=27376105 | doi=10.17294/2330-0698.1214 | pmc=4927079 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27376105  }}</ref><ref name="pmid30115336">{{cite journal| author=Grief SN, Loza JK| title=Guidelines for the Evaluation and Treatment of Pneumonia. | journal=Prim Care | year= 2018 | volume= 45 | issue= 3 | pages= 485-503 | pmid=30115336 | doi=10.1016/j.pop.2018.04.001 | pmc=7112285 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30115336  }}</ref>
!
!
!Advantages
!Advantages
Line 19: Line 19:
!Indications
!Indications
|-
|-
|'''PCV13 (Conjugate vaccine)'''
|'''PCV13 ([[Conjugate vaccine]])'''
|
|
*immune response is more effective, especially in the elderly and children under the age of 2
*Immune response is more effective, especially in the elderly and children under the age of 2
*long-lasting immunity due to the formation of memory B cells
*Long-lasting immunity due to the formation of [[B cells|memory B cells]]
*mucosal immunity (promotes herd immunity)
*[[Mucosal immunity]] (promotes herd immunity)
|
|
*protects against fewer serotypes
*Protects against fewer [[serotypes]]
|
|
*infants and childhood routine vaccines (children younger than 2 years)
*[[Infants]] and [[childhood]] [[routine vaccines]] (children younger than 2 years)
*all adults aged 65 years or older
*All [[Adult|adults]] aged 65 years or older
|-
|-
|'''PPSV23 (Polysaccharide vaccine''')
|'''PPSV23 ([[Polysaccharide|Polysaccharide vaccine]]''')
|
|
*protects against a wider range of serotypes
*Protects against a wider range of serotypes
|
|
*antibodies decline over 5 years
*[[Antibodies]] decline over 5 years
*does not produce an immunological response in children under the age of 2
*Does not produce an immunological response in children under the age of 2
|
|
*recommended for all adults over the age of 65
*Recommended for all adults over the age of 65
*recommended for ages 19-64 with certain medical conditions:
*Recommended for ages 19-64 with certain medical conditions:


#Chronic heart, lung, or liver diseases
#[[Chronic heart failure|Chronic heart]], [[lung]], or [[liver diseases]]
#Diabetics
#[[Diabetics]]
#Current smokers
#Current [[Smoking|smokers]]
#Alcoholics
#[[Alcoholic|Alcoholics]]
|-
|-
|'''PCV13 + PPSV23'''
|'''PCV13 + PPSV23'''
|
|
*Combined advantages of PCV13 and PPSV23
|
|
*Combined disadvantages of PCV13 and PPSV23
|
|
*All patients above the age of 65
*All patients above the age of 65
*Very high-risk patients below the age of 65
*Very high-risk patients below the age of 65


#Sickle cell disease and asplenia
#[[Sickle cell disease]] and [[asplenia]]
#Immunocompromised patient
#[[Immunocompromised]] patient
#Chronic kidney disease
#[[Chronic kidney disease]]
#CSF fluid leaks
#[[CSF]] fluid leaks


<br />
<br />
Line 61: Line 63:


=Controlling Underlying Comorbidities and Patient Education=
=Controlling Underlying Comorbidities and Patient Education=
<ref name="pmid30020693">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=30020693 | doi= | pmc= | url= }} </ref>
 


*Comorbidities significantly increase the [https://www.wikidoc.org/index.php/Bacterial_pneumonia_risk_factors risk of bacterial pneumonia] and should be controlled to aid in prevention. These include:
*Comorbidities significantly increase the [https://www.wikidoc.org/index.php/Bacterial_pneumonia_risk_factors risk of bacterial pneumonia] and should be controlled to aid in prevention. These include:
**Strict blood glucose and blood pressure control
**Strict [[blood glucose]] and [[blood pressure]] control
**Seeking treatment for chronic lung conditions such as COPD and Asthma
**Seeking treatment for [[chronic lung]] conditions such as [[COPD]] and [[Asthma]]
*Smoking Cessation
*[[Smoking]] Cessation
*Abstaining from alcohol overuse
*Abstaining from [[alcohol]] overuse
*Maintaining good dental hygiene
*Maintaining good [[dental hygiene]]
*The elderly and immunocompromised should consider medical assistance if they develop worrisome symptoms such as a fever accompanied by dyspnea and rigors
*The [[elderly]] and [[immunocompromised]] should consider medical assistance if they develop worrisome symptoms such as a fever accompanied by [[dyspnea]] and rigors<ref name="pmid30020693">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=30020693 | doi= | pmc= | url= }} </ref>


=Conditions Requiring Prophylaxis=
=Conditions Requiring Prophylaxis=
<br />For children that have asplenia (including functional asplenia, as seen in sickle-cell disease), daily antimicrobial prophylaxis with oral penicillin V in addition to immunization is recommended. For patients with a history of splenectomy, antibiotics should be continued for a period of 1 year after the surgery.<ref name="CDC" />  
For children that have [[asplenia]] (including functional asplenia, as seen in [[sickle-cell disease]]), daily antimicrobial prophylaxis with [[oral penicillin V]] in addition to immunization is recommended. For patients with a history of [[splenectomy]], [[antibiotics]] should be continued for a period of 1 year after the surgery.<ref name="CDC" />
 
=References=
=References=
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Pneumonia]]
[[Category:Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Up to Date]]


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Latest revision as of 01:04, 7 August 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

The goal of primary prevention is to prevent the occurrence of an illness or a disease before it ever occurs. In the case of bacterial pneumonia, primary prevention can be achieved by the administration of vaccination as well as attempting to control underlying comorbidities that may predispose an individual to pneumonia. Pneumococcus Vaccines include the PCV13 (Conjugate vaccine) and the PPSV23 (Polysaccharide vaccine). The PCV13 vaccine is indicated in infants and childhood routine vaccines (children younger than 2 years) as well as all adults aged 65 years or older whereas the PPSV23 vaccine is recommended for all adults over the age of 65 as well as adults aged 19-64 with certain medical conditions including chronic heart, lung, or liver diseases, diabetes, smokers and alcoholics. The killed intramuscular influenza vaccine should be given annually. Strict blood glucose and blood pressure control can help in preventing disease prevalence. When certain conditions are present, such as in children that have asplenia, it may also be helpful to treat with prophylactic antibiotics.[1] Educating the public as well as identifying those most susceptible to infection can help reduce the risk of pneumonia.

Vaccinations

- Routinely administered vaccines include:

  • Pneumococcus (Intramuscular Conjugate or polysaccharide vaccine)
  • Annual vaccine against H. influenza (Intramuscular killed vaccine)
Pneumococcus Vaccines[2][3]
Advantages Disadvanatges Indications
PCV13 (Conjugate vaccine)
  • Immune response is more effective, especially in the elderly and children under the age of 2
  • Long-lasting immunity due to the formation of memory B cells
  • Mucosal immunity (promotes herd immunity)
PPSV23 (Polysaccharide vaccine)
  • Protects against a wider range of serotypes
  • Antibodies decline over 5 years
  • Does not produce an immunological response in children under the age of 2
  • Recommended for all adults over the age of 65
  • Recommended for ages 19-64 with certain medical conditions:
  1. Chronic heart, lung, or liver diseases
  2. Diabetics
  3. Current smokers
  4. Alcoholics
PCV13 + PPSV23
  • Combined advantages of PCV13 and PPSV23
  • Combined disadvantages of PCV13 and PPSV23
  • All patients above the age of 65
  • Very high-risk patients below the age of 65
  1. Sickle cell disease and asplenia
  2. Immunocompromised patient
  3. Chronic kidney disease
  4. CSF fluid leaks


Controlling Underlying Comorbidities and Patient Education

Conditions Requiring Prophylaxis

For children that have asplenia (including functional asplenia, as seen in sickle-cell disease), daily antimicrobial prophylaxis with oral penicillin V in addition to immunization is recommended. For patients with a history of splenectomy, antibiotics should be continued for a period of 1 year after the surgery.[1]

References

  1. ↑ 1.0 1.1 https://www.cdc.gov/pneumococcal/clinicians/prevention.html. Missing or empty |title= (help)
  2. ↑ Hayward S, Thompson LA, McEachern A (2016). "Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ". J Patient Cent Res Rev. 3 (2): 111–115. doi:10.17294/2330-0698.1214. PMC 4927079. PMID 27376105.
  3. ↑ Grief SN, Loza JK (2018). "Guidelines for the Evaluation and Treatment of Pneumonia". Prim Care. 45 (3): 485–503. doi:10.1016/j.pop.2018.04.001. PMC 7112285 Check |pmc= value (help). PMID 30115336.
  4. ↑ "StatPearls". 2022. PMID 30020693.


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