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

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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

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### General Considerations

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* 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. [1]. 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.[2]
* When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivir can help prevent influenza.[3],[4]

## Vaccination

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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. [5]

## Hospital-acquired Pneumonia Prevention

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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

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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

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* 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.

## References

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1. ↑ Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993;270:1826–1831. PMID 8411526
2. ↑ Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(RR-4):1–28. PMID 10366138.
3. ↑ Jefferson T, Deeks JJ, Demicheli V, Rivetti D, Rudin M. Amantadine and rimantadine for preventing and treating influenza A in adults.Cochrane Database Syst Rev. 2004;(3):CD001169. PMID 15266442
4. ↑ Hayden FG, Atmar RL, Schilling M, Johnson C, Poretz D, Paar D, Huson L, Ward P, Mills RG. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999;341:1336–1343PMID 10536125
5. ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Retrieved 2012-09-06. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)