By Jessica Craig
What is pneumonia?
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills and difficulty breathing. Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. The body usually blocks these germs from entering your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good. Pneumonia often begins in the lungs and can spread to other parts of the body.[1] This is especially dangerous for seniors, because as a person ages their body’s natural response to fight off infection weakens.
Statistics
Pneumonia is the second-leading reason for the hospitalization of Medicare recipients, and more than 600,000 senior citizens are hospitalized every year. Pneumonia in the elderly happens fast, and the prognosis is challenging. The death rate for severe pneumonia is as high as 20 percent. The main cause of the loss of life is respiratory failure.[2]
Risk Factors
Chronic underlying diseases are one of the most significant components in pneumonia cases among the elderly. Sixty to 90 percent of senior-age pneumonia patients in hospitals have at least one underlying disease and many chronic diseases as one advances in age. Moreover, the immune function of patients also decreases with age, which leads to lung infection and death.[2] Other risk factors relative to pneumonia include being in a hospital intensive care unit, especially if the patient is on a ventilator. One is also more likely to get pneumonia if they have asthma, chronic obstructive pulmonary disease (COPD) or a heart disease. Smoking or other tobacco consumption also harms your body's biological protection against the bacteria and viruses that cause pneumonia. People who have HIV/AIDS, or who have had an organ transplant, or who have undergone chemotherapy treatment or long-term steroids, or have any type of weakened immune system are also at a greater risk of contracting pneumonia.[3]
Signs and symptoms
The signs and symptoms of pneumonia fluctuate from mild to severe, depending on circumstances such as the type of germ that is causing the infection, the age of the subject, and one’s general health. Mild signs and symptoms are usually like those of a cold or flu, but last for a more extended period. Says Mayo Clinic: “Signs and symptoms of pneumonia may include chest pain when you breathe or cough, confusion or changes in mental awareness, cough with phlegm, fatigue, ever, sweating, shaking chills, a lower-than-normal body temperature, nausea, vomiting, diarrhea, or shortness of breath.”[1]
Complications from pneumonia
A condition called bacteremia can occur in patients suffering from pneumonia, if bacteria caused the pneumonia. Bacteremia is the presence of viable bacteria in the circulating blood. Consequently, the lungs can pass the infection to other organs, possibly leading to organ failure. If a case of pneumonia is severe, or one has chronic underlying lung diseases, they may have difficulty inhaling enough oxygen. Pneumonia may cause fluid to build up in the thin space between the layers of tissue that line the lungs and chest cavity, called the pleura. Also, an abscess can occur if pockets of pus build up in the lungs.
Types of vaccines
There are two types of vaccines dedicated to pneumonia, known as pneumococcal vaccines: PPSV23 and PCV13. PCV13 is for children and elders with specific medical illnesses. The majority of adults receive the PPSV23 vaccines. The Centers for Disease Control and Prevention (CDC) recommends PPSV23 for all adults 65 years or older, people ages 2 through 64 years old with certain medical conditions, and adults 19 through 64 years who smoke cigarettes or consume tobacco products.[4]
How the vaccine works
Pneumococcal polysaccharide vaccine (PPSV23) can prevent pneumococcal disease, which refers to any illness caused by pneumococcal bacteria. These bacteria can cause many types of illnesses, including pneumonia. Pneumococcal bacteria are the most common causes of pneumonia. Besides pneumonia, pneumococcal bacteria can also cause ear infections, sinus infections, meningitis – an infection of the tissue covering the brain and spinal cord – or a bacteremiainfection in the bloodstream. PPSV23 shields 23 different types of pneumococcal bacteria. PPSV23 may be up to 80 percent successful if a person is over 64 and has a healthy immune system. Most people need only one dose of PPSV23 in their lifetime. However, a second dose of PPSV23, and another type of pneumococcal vaccine, PCV13, are recommended for certain high-risk groups. This vaccine is also remarkably safe, because there is no bacteria in the vaccine. This bacteria, streptococcus pneumoniae, has carbohydrates on the outside that our immune systems can easily recognize. So, instead of producing a vaccine with strains of the bacteria itself, scientists use the sterilized carbohydrates as the targets.[5]
Side effects
About 50 percent of people given the PPSV23 injection have slight side effects, such as redness or pain where the shot is given. Less than 1 percent experience fever, muscle aches or more severe reactions at the point of injection. The risk of a vaccine causing serious reaction or death is extremely low.5
References
[1] Mayo Clinic Staff. Pneumonia. Mayo Clinic Family Health Book 5th Edition. 2020. Retrieved from https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204.
[2] Li W., et al. Severe pneumonia in the elderly: a multivariate analysis of risk factors. Int J Clin Exp Med. 2015; 8 (8): 12463-12475. 15 Aug 2015.
[3] Bonten, M., et al. (2015). Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. New England Journal of Medicine.
[4] Cedars-Sinai staff. The Pneumonia Vaccine Explained. Cedars-Sinai blog. 2020. Retrieved from https://www.cedars-sinai.org/blog/pneumonia-vaccine.html.
[4] American Thoracic Society. (2019). Top 20 pneumonia facts – 2019.
[5] Bonten, M., et al. (2015). Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. New England Journal of Medicine.