More than 95% of deaths from pneumococcal pneumonia in the United States are in adults, yet approximately 67 million adults at increased risk remain unvaccinated, leaving them vulnerable.1

The best prevention technique for pneumonia is getting vaccinated. For adults aged 65 years and older who have not received any pneumococcal vaccines, 1 dose of PCV13 is recommended followed by 1 dose of PPSV23 administered 1 year later.2

Other methods for prevention include3:

  • Getting an annual flu shot
  • Practicing good hygiene
  • Quitting smoking
  • Maintaining good dental and health habits

Having a weakened immune system from disease or drugs; congenital or acquired asplenia; cerebrospinal fluid leaks; and chronic heart, lung (including asthma), liver, or renal disease raises the risk for developing pneumonia.4 Adults in a hospital intensive-care unit, especially those receiving mechanical ventilation, are also at increased risk.5

In a study published in the Annals of Internal Medicine, researchers surveyed general internists and family physicians from March to June 2012 and noted that one of the main barriers to adult vaccination was financial.6 The researchers deduced that not stocking vaccines probably contributed to low national coverage, but pneumococcal vaccine “coverage remains suboptimal, even though most physicians report[ed] stocking this vaccine…suggesting that stocking alone is insufficient to improve coverage.”6

Another reason behind suboptimal vaccination in older adults might actually be diagnosis.  For example, in bacterial pneumonia, some classic signs are less frequent with increasing age.  “Chest pain is less commonly reported in older patients (estimates between 24% and 37%) than in younger patients with pneumonia (estimates between 45% and 67%).”7 The researchers noted that “older patients are less likely to present with classic radiologic findings” and that “establishing a microbiological etiology is often limited by the inability to produce a good-quality expectorated respiratory sample.” 7 Since “imaging findings may be less reliable in older adults, and comorbidities may cause similar changes on radiographs, the combination of careful history, physical examination, and noninvasive testing still facilitates the diagnosis of pneumonia in most seniors.”7

While the methods listed help in the correct diagnosis of pneumonia in older adults in the primary care setting, there are ways to improve pneumococcal immunization rates among hospitalized adults. Although most hospitalized patients are screened for immunization during admission, one study found that changing the process of screening the patient for the pneumococcal vaccine during discharge and using the functions of the electronic medical record greatly improved immunization rates.8

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References

  1. Pneumococcal disease: fast facts. Center for Disease Control and Prevention website.http://www.cdc.gov/pneumococcal/about/facts.html. Updated June 10, 2015. Accessed September 14, 2016.
  2. Pneumococcal vaccine timing for adults. Centers for Disease Control and Prevention website.https://www.cdc.gov/vaccines/vpd-vac/pneumo/downloads/adult-vax-clinician-aid.pdf. Updated November 30, 2015. Accessed September 15, 2016.
  3. Pneumonia. American Lung Association website. http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/preventing-pneumonia.html. Accessed September 15, 2016.
  4. Risk factors. Center for Disease Control and Prevention website.https://www.cdc.gov/pneumococcal/clinicians/risk-factors.html. Updated June 10, 2015.  Accessed September 16, 2016.
  5. Who is at risk for pneumonia? National Heart, Lung, and Blood Institute website.http://www.nhlbi.nih.gov/health/health-topics/topics/pnu/atrisk. Updated March 1, 2011. Accessed September 16, 2016.
  6. Hurley LP, Bridges CB, Harpaz R, et al. U.S. physicians’ perspective of adult vaccine deliveryAnn Intern Med. 2014;160(3):161. doi: 10.7326/M13-2332.
  7. van Duin D. Diagnostic challenges and opportunities in older adults with infectious diseasesClin Infect Dis. 2012;54(7):973-978. doi: 10.1093/cid/cir927.
  8. Schurlknight M. Improving pneumococcal immunization rates among hospitalized adultsNurs Econ. 2015;33(3):182-185.