Pneumonia prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Priyamvada Singh, M.D. [3] ; Alejandro Lemor, M.D. [4]

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Overview

There are several ways to prevent infectious pneumonia. Appropriately treating underlying illnesses (such as AIDS), smoking cessation, vaccination against pneumococcal, and influenza are the commonly used methods.

Prevention

General Considerations

• There are several ways to prevent infectious pneumonia. Appropriately treating underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia.
• Smoking cessation is important not only because it helps to limit lung damage, but also because cigarette smoke interferes with many of the body's natural defenses against pneumonia.
• Research shows that there are several ways to prevent pneumonia in newborn infants. Testing pregnant women for Group B Streptococcus and chlamydia trachomatis, and then giving antibiotic treatment if needed, reduces pneumonia in infants. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia.
• Vaccination is important for preventing pneumonia in both children and adults. Vaccinations against haemophilus influenzae and streptococcus pneumoniae in the first year of life have greatly reduced their role in pneumonia in children.
• Vaccinating children against streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. A vaccine against streptococcus pneumoniae is also available for adults. . Influenza vaccines should be given yearly to the same individuals who receive vaccination against streptococcus pneumoniae. In addition, health care workers, nursing home residents, and pregnant women should receive the vaccine.
• When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivir can help prevent influenza.^,

Vaccination

Vaccine	Route of Administration	Type of Vaccine	Recommended Groups	Specific high-risk indications for vaccination	Re-vaccination schedule
Pneumococcal Vaccine	Intramuscular injection	Pneumococcal polysaccharide vaccine	All persons > 65 years of age, high-risk persons 2–64 years of age, current smokers	Chronic cardiovascular, pulmonary, renal, or liver disease, diabetes mellitus, cerebrospinal fluid leaks, alcoholism, asplenia, immunocompromising conditions/medications, native Americans and Alaska natives, long-term care facility residents Residence	One-time revaccination after 5 years for: Adults > 65 years of age, if the first dose is received before age 65 years Persons with asplenia Immunocompromised persons.
Inactivated Influenza Vaccine	Intramuscular injection	Killed virus	All persons > 50 years of age, High-risk persons 6 months–49 years of age, household contacts of high-risk persons, health care providers, children 6–23 months of age	Chronic cardiovascular or pulmonary disease (including asthma), Chronic metabolic disease (including diabetes mellitus), Renal dysfunction, Hemoglobinopathies, Immunocompromising conditions/medications, Compromised respiratory function or increased aspiration risk, pregnancy, aspirin therapy in persons < 18 years of age	Annualy
Live Attenuated Influenza Vaccine	Intranasal spray	Live virus	Healthy persons 5–49 years of age,a including health care providers and household contacts of high-risk persons	Avoid in high-risk persons	Annualy
Adapted from IDSA/ATS Consensus Guidelines on the Vaccine Prevention for Community-Acquired Pneumonia in Adults.

Hospital-acquired Pneumonia Prevention

The prevention for hospital-acquired pneumonia (HAP) includes education of health-care workers about the epidemiology and infection-control procedures, and involve the workers in the implementation of interventions to prevent HAP by using performance-improvement tools and technique. Disinfection and maintenance of equipment and devices, as well as preventive measures of person to person transmission, are part of the preventive recommendations given by the CDC for HAP.

Click here for detailed information in the prevention of hospital-acquired pneumonia

Risk for travellers

Before travelling to countries with limited access to modern healthcare facilities, vaccination against invasive pneumococcal disease is advisable for children <2 years of age and for children and adults considered to be at particular risk of serious disease.

Vaccine

• Conjugate vaccines that include 10 (PCV10) or 13 (PCV13) pneumococcal serotypes. These pneumococcal conjugate vaccines (PCVs) are safe and efficacious and may be used from the age of 6 weeks. PCV10 and PCV13 are licensed for immunization against invasive disease, pneumonia and acute otitis media caused by the respective vaccine serotypes of S. pneumoniae.
• A pneumococcal polysaccharide vaccine that includes 23 serotypes (PPV23). This vaccine is licensed for individuals aged 2 years or older. It is safe and efficacious against invasive pneumococcal disease and pneumonia in healthy young adults, but shows limited efficacy in other age groups including elderly persons.