Streptococcus pneumoniae

What Is the Pneumococcal Pneumonia Vaccine?
The pneumococcal vaccine protects against infections from a type of bacteria called pneumococcus. Pneumococcus is a common cause of pneumonia (a lung infection), as well as other serious infections. The vaccine prepares your immune system to recognize and fight pneumococcal bacteria. The vaccine is usually given through an injection into the arm. Some versions can also be inhaled. The vaccines do not contain living or dead bacteria. The pneumococcal vaccine does not protect you from other lung infections like the flu (influenza), COVID-19, RSV (respiratory syncytial virus), or other kinds of bacteria that cause pneumonia. It is still important to get your flu shot every year and other vaccines your doctor recommends, even if you already got the pneumococcal vaccine.

What Are Benefits of Pneumococcal Pneumonia Vaccines?
The vaccine substantially lowers your risk of hospitalization or dying from serious pneumococcal infection. Vaccination can reduce the risk of pneumonia-related deaths by almost half.

Why Is There a New Pneumococcal Pneumonia Vaccine, and How Does It Differ From Prior Versions?
There are several types of pneumococcal bacteria that can cause pneumonia. Being vaccinated against one type of pneumococcus may not protect you from other types that could make you sick. Previous pneumococcal pneumonia vaccines like PPSV23 or PCV13 do not protect against all types of the pneumococcal bacteria that cause pneumonia. Newer vaccines were made in 2021 (PCV15 and PCV20) and 2024 (PCV21). These help to prevent infections from types of bacteria not covered by older versions.

What Are the Potential Side Effects?
Side effects are frequent but generally mild. The most common side effect is pain or redness at the site of injection. Less common side effects include fever, feeling tired, muscle ache, and headache. These are less severe than for other vaccines like flu and shingles. These effects can be treated with over-the-counter medications and generally go away within 24 to 48 hours. Life-threatening allergic reactions are extremely rare but possible. Seek immediate medical attention if you experience severe symptoms like difficulty breathing or progressive weakness after vaccination. The pneumonia vaccine cannot cause pneumonia or other bacterial illness.

Who Should Get a New Pneumococcal Pneumonia Vaccine?
All adults 50 years and older who have not been vaccinated should receive one of the new vaccines: PCV21, PCV20, or a sequence of PCV15 followed by PPSV23. People younger than 50 years with certain health problems should also get the new vaccine. These health problems include diabetes; chronic conditions affecting the heart, lungs, liver, or kidneys; current tobacco use or heavy alcohol consumption; a weak immune system from certain health problems or medications; absence or prior removal of the spleen; and a history of spinal fluid leak or a cochlear (inner ear) implant.

Most adults who got either PPSV23 and/or PCV13 should still get a booster with one of the newer vaccines. The different pneumococcal vaccines protect against different types of bacteria. Some types of bacteria are more common in people depending on their age, health, and where they live. Talk to your doctor about which vaccine is best for you.

Author/s:

Jerard Z. Kneifati-Hayek, Michael A. Incze

Community-Acquired Pneumonia: A Review

Alex Haga — Wed, 18 Sep 2024 17:02:31 +0000

Date Added:

September 18, 2024

Journal/Publication:

JAMA

Publication Date:

September 16, 2024

URL:

Community-Acquired Pneumonia: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.14796

Keywords

community acquired pneumonia

pneumonia

PMID (1):

39283629

MeSH

pneumonia

Streptococcus pneumoniae

Ceftriaxone

COVID-19

Respiratory Distress Syndrome

A review of current thinking regarding the diagnosis and treatment of patients with community acquired pneumonia. James W. Mold, MD, MPH

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Importance: Community-acquired pneumonia (CAP) results in approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually.

Observations: Community-acquired pneumonia can be diagnosed in a patient with 2 or more signs (eg, temperature >38 °C or ≤36 °C; leukocyte count <4000/μL or >10 000/μL) or symptoms (eg, new or increased cough or dyspnea) of pneumonia in conjunction with consistent radiographic findings (eg, air space density) without an alternative explanation. Up to 10% of patients with CAP are hospitalized; of those, up to 1 in 5 require intensive care. Older adults (≥65 years) and those with underlying lung disease, smoking, or immune suppression are at highest risk for CAP and complications of CAP, including sepsis, acute respiratory distress syndrome, and death. Only 38% of patients hospitalized with CAP have a pathogen identified. Of those patients, up to 40% have viruses identified as the likely cause of CAP, with Streptococcus pneumoniae identified in approximately 15% of patients with an identified etiology of the pneumonia. All patients with CAP should be tested for COVID-19 and influenza when these viruses are common in the community because their diagnosis may affect treatment (eg, antiviral therapy) and infection prevention strategies. If test results for influenza and COVID-19 are negative or when the pathogens are not likely etiologies, patients can be treated empirically to cover the most likely bacterial pathogens. When selecting empirical antibacterial therapy, clinicians should consider disease severity and evaluate the likelihood of a bacterial infection-or resistant infection-and risk of harm from overuse of antibacterial drugs. Hospitalized patients without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days. Systemic corticosteroid administration within 24 hours of development of severe CAP may reduce 28-day mortality.

Conclusions: Community-acquired pneumonia is common and may result in sepsis, acute respiratory distress syndrome, or death. First-line therapy varies by disease severity and etiology. Hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria can be treated with β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, for a minimum of 3 days.

Author/s:

Valerie M Vaughn, Robert P Dickson, Jennifer K Horowit, Scott A Flanders

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial

Bethie Seay — Sun, 07 Nov 2021 05:00:00 +0000

Date Added:

November 7, 2021

Journal/Publication:

JAMA

Publication Date:

November 2, 2021

Issue:

Volume:

326

Pages:

1713-1724

Type:

Clinical Research Results

DOI (1):

10.1001/jama.2021.17843

3 days of standard dose amoxicillin was as effective as 7 days of high-dose amoxicillin for treatment of CAP in children discharged from an ED. In both cases, additional antibiotic treatment was required subsequently in around 12.5% of kids.

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Importance
The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear.

Objective
To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days.

Design, Setting, and Participants
Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019.

Interventions
Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401).

Main Outcomes and Measures
The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates.

Results
Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI –∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI –∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, –∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, –∞ to 7.4%]; P value for interaction = .73).

Conclusions and Relevance
Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings.

Trial Registration
ISRCTN Identifier: ISRCTN76888927

Author/s:

Bielicki, J. A., Stöhr, W., Barratt, S., Dunn, D., Naufal, N., Roland, D., Sturgeon, K., Finn, A., Rodriguez-Ruiz, J. P., Malhotra-Kumar, S., Powell, C., Faust, S. N., Alcock, A. E., Hall, D., Robinson, G., Hawcutt, D. B., Lyttle, M. D., Gibb, D. M., Sharland, M.