Prevention:

The best way to prevent serious respiratory infections such as pneumonia is to avoid sick people (if possible), and to practice good hygiene. [See In-Depth Report #94: Colds and influenza.]

Good Hygiene and Preventing Transmission

Colds and flu are spread primarily from infected people who cough or sneeze. A very common method for transmitting a cold is by shaking hands. Research has found that washing hands frequently can prevent the spread of viral respiratory illnesses. Always wash your hands before eating and after going outside. Using ordinary soap is sufficient. Alcohol-based gels are also effective for everyday use, and may even kill cold viruses. If extreme hygiene is required, use alcohol-based rinses.

Antibacterial soaps add little protection, particularly against viruses. In fact, one study suggested that common liquid dishwashing soaps are up to 100 times more effective than antibacterial soaps in killing respiratory syncytial virus (RSV). Wiping surfaces with a solution that contains one part bleach to 10 parts water is very effective at killing viruses.

Changing Hospital Practices

Bacteria abound in hospitals and long-term care facilities, and are particularly able to cause disease in areas with the sickest patients, such as intensive care units. Health care facilities are changing many of their practices and educating physicians, nurses, and therapists on how to reduce the likelihood of transmitting bacteria.

Vaccines

Viral Influenza Vaccines (Flu Shot)

Description of Vaccines. Vaccines against the flu (or a "flu shot") use inactivated (not live) viruses. They are designed to provoke the immune system to attack antigens contained on the surface of the virus. Antigens are foreign molecules that the immune system recognizes and targets for attack.

Timing and Effectiveness of the Vaccine. Ideally, people should get a flu shot every October or November. However, it may take longer for a full supply of the vaccine to reach certain locations. In such cases, high-risk groups should get vaccinated first.

According to the U.S. Centers for Disease Control and Prevention (CDC), anyone who wants to reduce their risk of getting the flu should have a flu vaccine.

Older children and adults require only a single shot each year. However, children under age 9 may need two shots given 1 month apart the first time they receive the flu vaccine, or if they have not previously received two doses during a flu season.

Some people have a higher risk of the disease.

The following people should get a flu vaccine every year:

• Children ages 6 months to 18 years
• Children over age 5 who have a higher risk for serious illness
• Household contacts and caregivers of children or adults with high-risk conditions (breastfeeding women may receive the vaccine)

You should be vaccinated each year if you:

• Are age 50 or older
• Have chronic lung or heart disease
• Have sickle cell anemia or other inherited blood disease (hemoglobinopathy)
• Live in a nursing home or extended-care facility
• Live with people who have chronic health problems
• Have kidney disease, anemia, severe asthma, diabetes, or chronic liver disease
• Have a weakened immune system (including those with cancer or HIV/AIDS)
• Receive long-term treatment with steroids for any condition
• Are a pregnant woman
• Are a woman who will be pregnant during flu season

The flu shot is encouraged for:

• Health care providers
• People who have in-home contact with children who are younger than age 5
• People who provide essential community services
• People living in dormitories or other crowded conditions
• Any adult age 18 - 50 who wants to reduce his or her chance of getting influenza

Pneumococcal Vaccines

The pneumococcal vaccine protects against S. pneumoniae bacteria, the most common cause of respiratory infections. There are two effective vaccines available:

• 23-valent polysaccharide vaccine (Pneumovax, Pnu-Immune) for adults
• 7-valent conjugate vaccine (Prevnar or PCV7) for infants and young children

Experts are now recommending that more people, including healthy elderly people, be given the pneumococcal vaccine, particularly in light of the increase in antibiotic-resistant bacteria.

Pneumococcal Vaccine in Young Children. The pneumococcal vaccine (Prevnar or PCV7) is very effective in children. Routine vaccination with the PCV7 vaccine began in 2000. The vaccine cut the rate of infant hospitalizations for pneumonia by a third between 1997 - 1999 and 2006. Possibly due to "herd immunity," pneumonia-related hospital admissions in adults ages 18 - 39 also dropped by more than 25%.

Evidence suggests that this vaccination, plus the vaccination against Haemophilus influenzae (an important cause of meningitis), have led to 25,000 fewer cases of serious bacterial infections each year.

The pneumococcal vaccine is now recommended by many experts for all children up to age 2. The pneumococcal conjugate vaccine (Prevnar or PCV7) has now been added to the Recommended Childhood Immunization Schedule. The pneumococcal vaccine (Prevnar or PCV7) is very effective in children. Studies are suggesting that it prevents common ear infections, as well as serious infections such as pneumonia.

The recommended schedule of immunization for Prevnar (PCV7) is four doses, given at 2, 4, 6, and 12 - 15 months of age. Infants starting immunization between 7 and 11 months should have three doses. Children starting their vaccinations between 12 and 23 months need only two doses. Those who are over 2 years old need only one dose.

Pneumococcal Polysaccharide Vaccine in Older Children and Adults. The pneumococcal polysaccharide vaccine is proving to help reduce the rate of pneumonia in older children and adults. Its benefits for adults are unclear.

Still, pneumonia is declining among adults, which may be due to fewer infections transmitted from vaccinated young children.

The vaccine is recommended for:

• High-risk people age 2 or older (this includes persons with heart disease, all lung diseases except asthma, kidney disease, alcoholism, diabetes, cirrhosis, and leaks of cerebrospinal fluid)
• Everyone ages 65 and older
• Those with sickle cell disease
• Those who have had their spleen removed
• Persons who live in nursing homes (extended-care facilities)
• Persons who live in any institution where there are people with chronic health problems
• Persons with conditions that weaken the immune system, such as cancer, HIV, or organ transplantation
• Persons who receive long-term medications that suppress the immune system (immunosuppressants), including steroids
• Alaskan natives and certain Native American populations

A single dose of the vaccine is given by injection. One dose works for most people. However, re-vaccination is recommended for people over age 65 who received their first dose before age 65 and more than 5 years ago. Other high-risk people, including those with a weakened immune system or spleen problems may also need a second dose. You should speak with your doctor about specific reasons for vaccination and revaccination.

Because the vaccine is inactive, it is safe for pregnant women and people with immune problems. In fact, when the vaccine is given to pregnant women, it may actually protect their infants against certain respiratory infections.

Protection lasts for more than 6 years in most people, although it may wear off faster in elderly people than in younger adults. Anyone at risk for serious pneumonia should be revaccinated 6 years after the first dose, including those who were vaccinated before age 65. Later booster doses, however, are not recommended.

Preventing Respiratory Syncytial Virus (RSV) Pneumonia in Children

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make sure that other people, especially caregivers, take precautions to avoid giving RSV to your baby. The following simple steps can help protect your baby:

• Insist that others wash their hands with warm water and soap before touching your baby.
• Have others avoid contact with the baby if they have a cold or fever. It may be helpful for them to wear a mask.
• Be aware that kissing the baby can spread RSV infection.
• Try to keep young children away from your baby. RSV is very common among young children, and easily spreads from child to child.
• Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.

Prevention of RSV. Two medications have been approved for protecting high-risk children against RSV pneumonia:

• Palivizumab (Synagis) is known as a monoclonal antibody, a genetically engineered antibody that targets the RSV virus. It is given by an injection into the muscle. Early studies of motavizumab, another monoclonal antibody in development, also show that it protects against RSV.
• RSV immune globulin (RespiGam) is made up of antibodies to RSV that are taken from the blood of healthy infants. RespiGam is given as a shot.

Vitamins

Although some research supports the use of vitamin C for the prevention and treatment of pneumonia, most research says it's too early to recommend vitamin C supplements for the general population. These supplements may be helpful for pneumonia patients who are deficient in the vitamin, however.