What is the prophylaxis for pneumonia?

From the Guidelines

Pneumonia prophylaxis should prioritize vaccination, with a strong recommendation for influenza vaccine administration during the fall and winter, and pneumococcal polysaccharide vaccine for at-risk individuals, as stated in the Infectious Diseases Society of America/American Thoracic Society consensus guidelines 1.

Key Recommendations

• Vaccination status should be assessed at the time of hospital admission for all patients, especially those with medical illnesses, and vaccination may be performed either at hospital discharge or during outpatient treatment 1.
• Influenza vaccine should be offered to persons at hospital discharge or during outpatient treatment during the fall and winter, with the best time for vaccination in North America being October and November 1.
• Pneumococcal polysaccharide vaccine should be given to at-risk individuals, including those with medical illnesses, smokers, and individuals with close contact with infants <12 months of age 1.

Chemoprophylaxis

• Chemoprophylaxis can be used as an adjunct to vaccination for prevention and control of influenza, with oseltamivir and zanamivir being approved for prophylaxis, but not amantadine and rimantadine due to resistance concerns 1.
• Chemoprophylaxis may be useful during the 2-week period it takes to develop an adequate immune response to the inactivated influenza vaccine, especially for those with household exposure to influenza or at high risk for influenza complications 1.

Other Preventive Measures

• Smoking cessation should be a goal for persons hospitalized with community-acquired pneumonia (CAP) who smoke, as smoking is associated with a substantial risk of pneumococcal bacteremia and Legionella infection 1.
• Respiratory hygiene measures, including hand hygiene and masks or tissues for patients with cough, should be used in outpatient settings and emergency departments to reduce the spread of respiratory infections 1.

From the Research

Prophylaxis for Pneumonia

Prophylaxis for pneumonia involves measures to prevent the disease, including vaccination. The following points highlight the key aspects of prophylaxis for pneumonia:

• Vaccination Recommendations: The Advisory Committee on Immunization Practices (ACIP) recommends the use of pneumococcal conjugate vaccines (PCVs) for adults aged ≥50 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease 2.
• Types of Vaccines: There are several types of pneumococcal vaccines, including 20-valent PCV (PCV20), 21-valent PCV (PCV21), and 23-valent pneumococcal polysaccharide vaccine (PPSV23) 2, 3.
• Effectiveness of Vaccination: Studies have shown that influenza vaccination can reduce the incidence of influenza-related acute respiratory illness and hospitalization in patients with chronic obstructive pulmonary disease (COPD) 3. However, the effectiveness of pneumococcal vaccination in preventing pneumonia is still debated, with some studies showing a significant reduction in pneumonia rates and others showing no significant effect 4, 5.
• Dual Vaccination Strategy: A meta-analysis found that dual influenza and pneumococcal polysaccharide vaccination was associated with a significantly lower pneumonia rate and all-cause mortality rate compared to influenza vaccination alone in adults ≥65 years of age 5.
• Safety and Adverse Reactions: The safety profile of pneumococcal vaccines is generally good, with few reported adverse reactions 3. However, local and systemic reactions can occur, and the risk of adverse reactions should be carefully considered when administering vaccines.

Key Findings

The key findings from the studies are:

• Pneumococcal conjugate vaccines are recommended for adults aged ≥50 years and those with risk conditions for pneumococcal disease.
• Influenza vaccination can reduce the incidence of influenza-related acute respiratory illness and hospitalization in patients with COPD.
• The effectiveness of pneumococcal vaccination in preventing pneumonia is still debated.
• Dual influenza and pneumococcal polysaccharide vaccination may be associated with a lower pneumonia rate and all-cause mortality rate compared to influenza vaccination alone in adults ≥65 years of age.

Implications for Practice

The implications for practice are:

• Healthcare providers should follow the recommended vaccination schedules and guidelines for pneumococcal conjugate vaccines.
• Patients with COPD should receive influenza vaccination to reduce the risk of influenza-related acute respiratory illness and hospitalization.
• The decision to administer pneumococcal vaccination should be based on individual patient risk factors and medical history.
• Dual influenza and pneumococcal polysaccharide vaccination may be considered for adults ≥65 years of age to reduce the risk of pneumonia and all-cause mortality.