Ira Shah
Pneumonia - Prevention
Globally, pneumonia kills nearly 1 million children younger than 5 years of age each year. Although various pathogens may cause pneumonia, either singly or in combination, two bacteria are the leading causes: Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus). Hib and pneumococcus together account for more than 50% of pneumonia deaths among children aged 1 month to 5 years.
Vaccines can help prevent infection by some of the bacteria and viruses that can cause pneumonia. Vaccines are available for the following infections:
• Haemophilus influenzae type b (Hib)
• Influenza (flu)
• Measles
• Pertussis (whooping cough)
• Pneumococcal
• Varicella (chickenpox)

What are the other steps to prevent pneumonia apart from vaccines?
• Hand hygiene: Wash your hands often.
• Stay away from people who have cold, cough and fever.
• Avoid people with chickenpox and measles if you haven’t got the vaccines against them.
• Avoid smoking and smoking areas.
• Cough etiquette: Cough or sneeze into a tissue or a napkin instead of hands so that your germs do not spread to others.

Which are the vaccines for preventing pneumonia?
Routinely vaccines to prevent H.influenza B (Hib Vaccine), pertussis (DPT vaccine), measles (Measles or MMR vaccine) are given to all children. In addition, pneumococcal vaccine (PCV13) is now included in the universal immunization programme in some states in India and is routinely used in the western world in all children <5 years of age. Flu vaccine and Chickenpox vaccine is recommended in the high risk group. The immunization schedule of these vaccines are given in table 1.

Table 1: Immunization schedule of vaccines that can prevent pneumonia due to certain infection
Age Vaccines recommended
6 weeks DPT, HiB, PCV
10 weeks DPT, HiB, PCV
14 weeks DPT, HiB, PCV
9 months MMR
15 months MMR, Chicken pox, PCV booster
16-18 months DPT, HiB
4-6 years DPT booster, Chicken pox
10-12 years Tdap

PCV- Pneumococcal conjugate vaccine, MMR- Measles, Mumps, Rubella vaccine, Tdap- Tetanus, diphtheria, acellular pertussis vaccine, HiB- HiB vaccine, DPT - Diphtheria, pertussis, tetanus vaccine

How would vaccination help to prevent pneumonia?
World Health Organization (WHO) recommends the inclusion of both Hib and PCV vaccines in routine immunization programmes. Together, HibV and PCV, are expected to prevent at least 1,075,000 child deaths each year predominantly in developing countries, and with herd protection additional cases and deaths in older age groups.

Pneumococcal vaccine in children
There are 2 types of pneumococcal vaccines: polysaccharide unconjugated pneumococcal vaccine (PPSV23) and conjugated pneumococcal vaccine (PCV 13 and PCV 10). PCV10 (marketed as Synflorix) contains ten serotypes of pneumococcus (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F) which are conjugated to a carrier protein. PCV13(marketed as Prevenar13) contains thirteen serotypes of pneumococcus (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F). PCV13 is registered in over 150 countries and is part of the National Immunization Program in 115 of them, including India. PCV13 also provides protection against serotypes 3, 6A and 19A which are relevant in Indian context for the disease caused due to them. PCV13 contains serotype 19A and the antimicrobial resistance for serotype 19A is increasing globally.
• For routine immunization both PCV10 and PCV13 are licensed for children from 6 weeks to 5 years of age.
• Primary schedule (for both PCV10 and PCV13): 3 primary doses at 6, 10, and 14 weeks with a booster at age 12 through 15 months.
• Additionally, PCV13 is licensed for the prevention of pneumococcal diseases in adults > 50 years of age.

Pneumococcal vaccine in adults
Two pneumococcal vaccines for adults 65 years or older:
• A single dose of the Pneumococcal Conjugate Vaccine (PCV13) is recommended followed by dose of the Pneumococcal Polysaccharide Vaccine (PPSV23) at least 1 year later.
• If a patient has already received PPSV23, then PCV13 should be given at least 1 year after receipt of the most recent PPSV23 dose.

Pneumonia Pneumonia 11/09/2017
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